Provider Demographics
NPI:1427327832
Name:FAMILIA DENTAL PLAINVIEW PLLC
Entity type:Organization
Organization Name:FAMILIA DENTAL PLAINVIEW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & PAYER RELATIONS MAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:847-453-7396
Mailing Address - Street 1:2050 EAST ALGONQUIN ROAD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4166
Mailing Address - Country:US
Mailing Address - Phone:847-453-7396
Mailing Address - Fax:847-453-7396
Practice Address - Street 1:1601 KERMIT ST.
Practice Address - Street 2:STE 650
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-3934
Practice Address - Country:US
Practice Address - Phone:806-296-5236
Practice Address - Fax:806-296-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty