Organization
FAMILIA DENTAL SPFW PLLC
Active
Other names
Familia Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING PAYER RELATIONS MGR)
(847) 453-7396
Entity
Organization
Contact information
Practice address
100 E PETTIT AVE, 1A, FORT WAYNE, IN 46806-3003
(888) 988-4066
(847) 496-7603
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(888) 988-4066
(847) 496-7603
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/19/2014
Last updated
10/15/2021
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