NPIMap

Organization Active NPI

Familia Dental River Glen LLC

  • Dental Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1154794584
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FAMILIA DENTAL RIVER GLEN LLC
Practice address
142 E Capitol Dr
Milwaukee, WI 53212-1206
Phone
(414) 444-1823
Fax
(414) 963-1163
NPI assigned
Nov 6, 2015
Last updated
Jun 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brandon Alexander Taylor, CPCS
Title
Credentialing & Payer Relations Man
Phone
(847) 453-7396

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

142 E Capitol Dr
Milwaukee, WI 53212-1206

Mailing address

2050 East Algonquin Road
Suite 610
Schaumburg, IL 60173-4166
Phone (847) 453-7396

National Provider Directory

National Provider Directory
Tax ID family
Familia Dental River Glen LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

142 E Capitol Dr
Milwaukee, WI 53212
Phone (414) 444-1823

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1154794584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 EAST ALGONQUIN ROAD",
            "address_2": "SUITE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734166",
            "telephone_number": "847-453-7396",
            "fax_number": "847-453-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 E CAPITOL DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532121206",
            "telephone_number": "414-444-1823",
            "fax_number": "414-963-1163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL RIVER GLEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-06",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "CREDENTIALING & PAYER RELATIONS MAN",
        "authorized_official_telephone_number": "847-453-7396",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPCS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.