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General NPI Number Information
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NPI Number | 1659691426
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Entity Type | Organization
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Legal Business Name | FAMILIA DENTAL ABILENE PLLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 1365 BARROW ST.
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City | ABILENE
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State | TX
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Zip | 79605-5171
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Country | US
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Telephone | 365-480-4248
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Fax | 325-232-8669
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Provider Business Mailing Address
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Address Line | 2050 EAST ALGONQUIN ROAD SUITE 610
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City | SCHAUMBURG
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State | IL
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Zip | 60173-4166
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Country | US
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Telephone | 847-453-7396
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Fax | 847-453-7396
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Authorized Official
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Title or Position | CREDENTIALING & PAYER RELATIONS MAN
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Name | MR. BRANDON ALEXANDER TAYLOR
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Credential | CPCS
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Telephone | 847-453-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22535
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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