FAMILIA DENTAL ESL LLC NPI 1962792747

NPI Information

NPI: 1962792747
Provider Name: FAMILIA DENTAL ESL LLC

Doing Business As: FAMILIA DENTAL

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
2608 STATE ST.
EAST SAINT LOUIS, IL
ZIP 62205
Phone: (618) 857-2300
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FAMILIA DENTAL ESL LLC is a dental clinic center in East Saint Louis, IL. FAMILIA DENTAL ESL LLC NPI is 1962792747. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Familia Dental.

The provider's business location address is:

2608 STATE ST.
EAST SAINT LOUIS, IL
ZIP 62205-325
Phone: (618) 857-2300
Fax: (618) 857-2302

The provider's authorized official is Brandon Alexander Taylor .
The authorized official title is Credentialing & Payer Relations Man and has the following contact phone number (847) 453-7396.

The enumeration date for this NPI number is 4/13/2011 and was last updated on 6/25/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	019026920	ILLINOIS	No
2	261QD0000X	Clinic/Center	Dental			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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