Familia Dental Wheeling LLC
Clinic/Center, Dental in Wheeling, IL. Organization (NPI-2).
NPI number1801022462
StatusActive
Last updated in NPPESJun 25, 2021
Details
- NPI
- 1801022462
- Entity type
- Organization (NPI-2)
- Legal business name
- Familia Dental Wheeling LLC
- Organization subpart
- No
- Enumeration date
- Jun 9, 2009
- Certification date
- Jun 25, 2021
- Last updated
- Jun 25, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
| 1223G0001X | Dentist, General Practice | 019026020 | IL |
Other names
- Familia Dental (Doing Business As)
Practice location
542 W. Dundee RoadWheeling, IL 60090-3227
Phone 847-453-7396 · Fax 847-453-7396
Mailing address
2050 East Algonquin RoadSuite 610
Schaumburg, IL 60173-4166
Phone 847-453-7396 · Fax 847-453-7396
Authorized official
Brandon Alexander Taylor
Credentialing & Payer Relations Man
8474537396
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