Provider Demographics
NPI:1518412055
Name:KENDALL POINTE DENTAL LLC
Entity Type:Organization
Organization Name:KENDALL POINTE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACIERNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-339-3172
Mailing Address - Street 1:129 S ROSELLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5540
Mailing Address - Country:US
Mailing Address - Phone:630-339-3172
Mailing Address - Fax:
Practice Address - Street 1:1991 WIESBROOK RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8311
Practice Address - Country:US
Practice Address - Phone:630-339-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015469305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization