Organization · Type 2 NPI

Familia Dental Esl LLC

Dental Clinic/Center · East St. Louis, IL

NPI number 1962792747 Active

Practice location

2608 State St.
East St. Louis, IL 62205-2325

Call (618) 857-2300 Map

Fax (618) 857-2302

Mailing address

2050 East Algonquin Road, Suite 610
Schaumburg, IL 60173-4166

Specialties and licenses

Taxonomy	Code	License
General Practice Dentistry	1223G0001X	019026920 (IL)
Dental Clinic/Center Primary	261QD0000X	None listed

Dental Clinic/Center: Definition to come...

NPI record

NPI: 1962792747
Entity type: Organization (Type 2)
Issued: Apr 13, 2011
Last updated: Jun 25, 2021
Status: Active

Other names

<unavail>
Familia Dental · doing business as
Familia Dental · doing business as

Authorized official

Mr. Brandon Alexander Taylor, CPCS
Credentialing & Payer Relations Man
(847) 453-7396

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1962792747

Familia Dental Esl LLC's National Provider Identifier is 1962792747, issued on Apr 13, 2011. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in East St. Louis, IL. The record was last updated on Jun 25, 2021.