Organization
FAMILIA DENTAL MADISON EAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVONNE TELLEZ (ENROLLMENT TEAM LEAD)
(888) 988-4066
Entity
Organization
Contact information
Practice address
3003 E WASHINGTON AVE, MADISON, WI 53704-4301
(888) 988-4066
(847) 496-4850
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4144
(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
03/31/2016
Last updated
10/15/2021
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