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Organization

MEADOW LAKE DENTAL LLC

Active
Parent organization
ACIERNO DENTAL, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
ACIERNO DENTAL, LLC
Authorized official
ALAN J ACIERNO DDS (MANAGER)
(630) 339-3172
Entity
Organization

Contact information

Practice address
3941 75TH ST, SUITE 102, AURORA, IL 60504-7924
(630) 851-5130
(630) 851-5739
Mailing address
129 S ROSELLE RD STE 102, SCHAUMBURG, IL 60193-5538
(630) 339-3172
(847) 891-6775

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
019021506
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1144341108
NPPES
IL
Enumeration date
09/07/2014
Last updated
09/07/2014
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