NPIMap

Organization Active NPI

Familia Dental Los Lunas LLC

Doing business as Familia Dental

  • Dental Clinic/Center
  • Los Lunas, NM
National Provider Identifier
1417377177
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FAMILIA DENTAL LOS LUNAS LLC
Doing business as
Familia Dental
Practice address
1620 Main St NW
Ste D
Los Lunas, NM 87031-4891
Phone
(505) 565-0651
Fax
(505) 565-2031
NPI assigned
Apr 21, 2014
Last updated
Oct 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 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
Dental Clinic/Center 261QD0000X NU Primary
Dentist 122300000X NU

Addresses

Primary practice location

1620 Main St NW
Ste D
Los Lunas, NM 87031-4891

Mailing address

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

Other names 1

  • Familia Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1620 Main St NW
Ste D
Los Lunas, NM 87031
Phone (505) 565-0651

Practitioners & affiliated clinicians

Practitioners 6

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": "1398038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1417377177",
    "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": "1620 MAIN ST NW",
            "address_2": "STE D",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870314891",
            "telephone_number": "505-565-0651",
            "fax_number": "505-565-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL LOS LUNAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-21",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "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": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Familia Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Lunas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.