Familia Dental Mkemitchell LLC
Clinic/Center, Dental in Milwaukee, WI. Organization (NPI-2).
NPI number1609259266
StatusActive
Last updated in NPPESJul 8, 2021
Details
- NPI
- 1609259266
- Entity type
- Organization (NPI-2)
- Legal business name
- Familia Dental Mkemitchell LLC
- Organization subpart
- No
- Enumeration date
- Jul 1, 2015
- Certification date
- Jul 8, 2021
- Last updated
- Jul 8, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
| 1223G0001X | Dentist, General Practice | 1001130 | WI |
Practice location
821 S Layton BlvdMilwaukee, WI 53215-1225
Phone 888-988-4066 · Fax 847-496-4850
Mailing address
2050 E Algonquin RdSchaumburg, IL 60173-4144
Phone 888-988-4066 · Fax 847-496-4850
Authorized official
Brandon Taylor
Credentialing & Payor Relations Mgr
8474537396
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