| Familia Dental Llc | |
|
200 W. Lake St. Addison IL 60101-2513 | |
| (630) 628-3115 | |
| (630) 628-3116 |
| Full Name | Familia Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 200 W. Lake St., Addison, Illinois |
| Authorized Official Name and Position | Brandon Alexander Taylor (CREDENTIALING & PAYER RELATIONS MAN) |
| Authorized Official Contact | 8474537396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Familia Dental Llc 2050 East Algonquin Road Suite 610 Schaumburg IL 60173-4166 Ph: (847) 453-7396 | Familia Dental Llc 200 W. Lake St. Addison IL 60101-2513 Ph: (630) 628-3115 |
| NPI Number | 1326288275 |
|---|---|
| Provider Enumeration Date | 03/04/2009 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326288275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Illinois) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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