| Familia Dental River Glen Llc | |
|
142 E Capitol Dr Milwaukee WI 53212-1206 | |
| (414) 444-1823 | |
| (414) 963-1163 |
| Full Name | Familia Dental River Glen Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 142 E Capitol Dr, Milwaukee, Wisconsin |
| 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 River Glen Llc 2050 East Algonquin Road Suite 610 Schaumburg IL 60173-4166 Ph: (847) 453-7396 | Familia Dental River Glen Llc 142 E Capitol Dr Milwaukee WI 53212-1206 Ph: (414) 444-1823 |
| NPI Number | 1154794584 |
|---|---|
| Provider Enumeration Date | 11/06/2015 |
| Last Update Date | 06/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154794584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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