Organization
FAMILIA DENTAL CHAMPAIGN 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
1905 W. SPRINGFIELD AVE, CHAMPAIGN, IL 61821-3011
(217) 355-6396
(217) 355-6872
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
Primary
019026920
IL
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
02/04/2015
Last updated
06/25/2021
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