Organization
FAMILIA DENTAL TERRE HAUTE LLC
Active
Other names
Vivid Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON ALEXANDER TAYLOR CPCS (CREDENTIALING&PAYERRELATIONSMANAGER)
(847) 453-7396
Entity
Organization
Contact information
Practice address
2512 WABASH AVE, TERRE HAUTE, IN 47803-1506
(888) 988-4066
Mailing address
2050 E ALGONQUIN RD STE 610, SCHAUMBURG, IL 60173-4166
(888) 988-4066
(847) 496-4850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/13/2019
Last updated
10/21/2021
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