Familia Dentalclovis LLC

NPI #1841583291 in Clovis, New Mexico

Provider Information

NPI Number: 1841583291
Entity Type: Organization
Organization Name: Familia Dentalclovis LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 18, 2011
Last Updated: Jun 24, 2021

Practice Location

Address: 4017 N PRINCE ST
City: Clovis
State: New Mexico
ZIP Code: 88101-9705
Phone: (575) 762-2757

Authorized Official

Name: MR. BRANDON ALEXANDER TAYLOR, CPCS
Title: CREDENTIALING & PAYER RELATIONS MGR
Phone: (847) 453-7396

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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