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Organization
ROUTE 64 DENTAL LLC
Active
Organization
ROUTE 64 DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN M ACIERNO (CFO)
(630) 339-3172
Entity
Organization
Contact information
Practice address
306 W MAIN ST, ST CHARLES, IL 60174-1814
(630) 584-6177
Mailing address
1699 E WOODFIELD RD STE 102, SCHAUMBURG, IL 60173-4955
(630) 339-3172
(847) 891-6775
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019012964
IL
1223G0001X
General Practice Dentistry
019015977
IL
Other
Enumeration date
08/31/2017
Last updated
08/31/2017
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