| Familia Dental Champaign Llc | |
|
1905 W. Springfield Ave Champaign IL 61821-3011 | |
| (217) 355-6396 | |
| (217) 355-6872 |
| Full Name | Familia Dental Champaign Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1905 W. Springfield Ave, Champaign, Illinois |
| Authorized Official Name and Position | Brandon Alexander Taylor (CREDENTIALING PAYER RELATIONS MGR) |
| Authorized Official Contact | 8474537396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Familia Dental Champaign Llc 2050 E Algonquin Rd Suite 610 Schaumburg IL 60173-4144 Ph: (888) 988-4066 | Familia Dental Champaign Llc 1905 W. Springfield Ave Champaign IL 61821-3011 Ph: (217) 355-6396 |
| NPI Number | 1982094462 |
|---|---|
| Provider Enumeration Date | 02/04/2015 |
| Last Update Date | 06/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982094462 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | 019026920 (Illinois) | Primary |
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