NPIMap

Organization Active NPI

Familia Dental Davenport LLC

  • General Practice Dentistry
  • Davenport, IA
National Provider Identifier
1205287067
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
09227 Issued in IA
Legal business name
FAMILIA DENTAL DAVENPORT LLC
Practice address
3301 W Kimberly Rd Ste 5
Davenport, IA 52806-3047
Phone
(888) 988-4066
Fax
(847) 496-4850
NPI assigned
Jun 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 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
Credentaling & Payer Relations MGR
Phone
(847) 453-7396

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 09227 IA Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

3301 W Kimberly Rd Ste 5
Davenport, IA 52806-3047

Mailing address

2050 E Algonquin Rd Ste 610
Suite 610
Schaumburg, IL 60173-4166
Phone (847) 453-7396

National Provider Directory

National Provider Directory

Locations

3301 W Kimberly Rd
Ste 5
Davenport, IA 52806

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1205287067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD STE 610",
            "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": "3301 W KIMBERLY RD STE 5",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528063047",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL DAVENPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-23",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "CREDENTALING & PAYER RELATIONS MGR",
        "authorized_official_telephone_number": "847-453-7396",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPCS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "09227",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.