| Familia Dental | |
|
100 E Pettit Ave 1a Fort Wayne IN 46806-3003 | |
| (888) 988-4066 | |
| (847) 496-7603 |
| Full Name | Familia Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 100 E Pettit Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | Brandon Alexander Taylor (CREDENTIALING PAYER RELATIONS MGR) |
| Authorized Official Contact | 8474537396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Familia Dental 2050 E Algonquin Rd Suite 610 Schaumburg IL 60173-4144 Ph: (888) 988-4066 | Familia Dental 100 E Pettit Ave 1a Fort Wayne IN 46806-3003 Ph: (888) 988-4066 |
| NPI Number | 1619388063 |
|---|---|
| Provider Enumeration Date | 05/19/2014 |
| Last Update Date | 10/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619388063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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