Main Street Dentistry LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

MAIN STREET DENTISTRY LLC

Practice address

801 Main Street NW
Bourbonnais, IL 60914

Phone

(815) 932-3516

NPI assigned

Jul 17, 2015

Last updated

Sep 15, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alan M. Acierno, DDS

Title

Chief Financial Officer

Phone

(630) 339-3172

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derek Leo Oconnor, DDS

  • Dentist
  • Bourbonnais, IL
  • NPI 1376112698
  NPD (past)
• Kelly L Oconnor, DDS

  • Dentist
  • Bourbonnais, IL
  • NPI 1588833917
  NPD (past)

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1316321524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 S. ROSELLE RD",
            "address_2": "STE. 102",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "60193",
            "telephone_number": "630-339-3172",
            "fax_number": "847-891-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MAIN STREET NW",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-932-3516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "ACIERNO",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "630-339-3172",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc (Pearle Vision #6315)
• Edward Joseph Machala, RPH
• Carolyn Macias, FNP-C
• Inez G Mackey
• Taruna Madhav Crawford, MD
• Shannon Kathleen Male, FNP-BC
• Robert Vincent Malicki, RPH
• McKenzie Mallard
• Brian C Malliett, EDD
• Victoria Malloy, LCPC

• Preferred Provider Organization in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Preferred Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.