Familia Dental Racine LLC

NPI #1962883926 in Racine, Wisconsin

Provider Information

NPI Number: 1962883926
Entity Type: Organization
Organization Name: Familia Dental Racine LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jun 16, 2015
Last Updated: Jun 25, 2021

Practice Location

Address: 5201 WASHINGTON AVE
Address 2: STE A
City: Racine
State: Wisconsin
ZIP Code: 53406-4242
Phone: (262) 634-0441

Authorized Official

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

Specialties & Taxonomy Codes

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

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