Organization
FAMILIA DENTAL MKEMITCHELL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON TAYLOR CPCS (CREDENTIALING & PAYOR RELATIONS MGR)
(847) 453-7396
Entity
Organization
Contact information
Practice address
821 S LAYTON BLVD, MILWAUKEE, WI 53215-1225
(888) 988-4066
(847) 496-4850
Mailing address
2050 E ALGONQUIN RD, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-4850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1001130
WI
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/01/2015
Last updated
07/08/2021
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