Provider Demographics
NPI:1376983684
Name:MICHAEL A. ACIERNO, DDS PC
Entity Type:Organization
Organization Name:MICHAEL A. ACIERNO, DDS PC
Other - Org Name:ACIERNO FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACIERNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-339-3172
Mailing Address - Street 1:6749 N OSHKOSH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1162
Mailing Address - Country:US
Mailing Address - Phone:630-339-3172
Mailing Address - Fax:847-891-6775
Practice Address - Street 1:6749 N OSHKOSH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1162
Practice Address - Country:US
Practice Address - Phone:630-339-3172
Practice Address - Fax:847-891-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty