NPIMap

Organization Active NPI

Familia Dentalclovis LLC

Doing business as Familia Dental

  • General Practice Dentistry
  • Clovis, NM
National Provider Identifier
1841583291
Registry record updated Jun 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAMILIA DENTALCLOVIS LLC
Doing business as
Familia Dental
Practice address
4017 N Prince St
Clovis, NM 88101-9705
Phone
(575) 762-2757
Fax
(575) 762-2769
NPI assigned
May 18, 2011
Last updated
Jun 24, 2021By the provider in NPPES
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
Credentialing & Payer Relations MGR
Phone
(847) 453-7396

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

4017 N Prince St
Clovis, NM 88101-9705

Mailing address

2050 E Algonquin Rd
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

4017 N Prince St
Clovis, NM 88101
Phone (575) 762-2757

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": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624492800000",
    "number": "1841583291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "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": "4017 N PRINCE ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019705",
            "telephone_number": "575-762-2757",
            "fax_number": "575-762-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTALCLOVIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "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": "CREDENTIALING & PAYER RELATIONS MGR",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILIA DENTAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILIA DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clovis, NM

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.