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NPI Code Detail

MEDICARE: FAMILIA DENTAL WEST GREEN BAY

MEDICARE: FAMILIA DENTAL WEST GREEN BAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1588197149
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILIA DENTAL WEST GREEN BAY
Provider Business Mailing Address
First Line : 2050 E ALGONQUIN RD STE 610
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60173-4166
Country : US
Telephone Number : 888-988-4066
Fax Number : 847-496-4850
Provider Business Practice Location Address
First Line : 2280 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4707
Country : US
Telephone Number : 888-988-4066
Fax Number : 847-496-4850
Authorized Official
Title or Position : CREDENTIALING & PAYER RELATIONS MGR
Name : BRANDON ALEXANDER TAYLOR
Credential : CPCS
Telephone Number : 847-453-7396
Provider Enumeration Date : 04/10/2017
Last Update Date : 10/15/2021

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Directions to “FAMILIA DENTAL WEST GREEN BAY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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