Familia Dental Esl LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FAMILIA DENTAL ESL LLC

Practice address

2608 State St.
East Saint Louis, IL 62205-2325

Phone

(618) 857-2300

Fax

(618) 857-2302

NPI assigned

Apr 13, 2011

Organization subpart

No

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

Addresses

Other names 1

• Familia Dental Doing business as

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1962792747",
    "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": "2608 STATE ST.",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622052325",
            "telephone_number": "618-857-2300",
            "fax_number": "618-857-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL ESL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "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 SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026920",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "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"
        }
    ]
}

• East St Louis Dist 189
• Edgemont Pediatrics, P.C
• Cheryl Lynn Eubanks
• Familia Dental Esl 4 LLC
• Familia Dental Esl 4LLC
• David Felts
• Jeffrey Fields, RPH
• Wendy Fleming, RN
• Catina Demetris Floore
• Sylvia A. Florian, CNP

• Dental Clinic/Center in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.