Organization
FAMILIA DENTALCLOVIS LLC
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
4017 N PRINCE ST, CLOVIS, NM 88101-9705
(575) 762-2757
(575) 762-2769
Mailing address
2050 E ALGONQUIN RD, SUITE 610, SCHAUMBURG, IL 60173-4166
(847) 453-7396
(847) 453-7396
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
05/18/2011
Last updated
06/24/2021
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