590 Dental Care LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

019018431 Issued in IL

Legal business name

590 DENTAL CARE LLC

Practice address

590 William R Latham Sr Dr
Bourbonnais, IL 60914-2320

Phone

(630) 339-3172

NPI assigned

Mar 22, 2016

Last updated

Mar 28, 2016By 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 J Acierno, DDS

Title

Manager

Phone

(630) 339-3172

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459123200000",
    "number": "1326400078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 S ROSELLE RD",
            "address_2": "SUITE 102",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601935540",
            "telephone_number": "630-339-3172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 WILLIAM R LATHAM SR DR",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142320",
            "telephone_number": "630-339-3172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "590 DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-28",
        "status": "A",
        "authorized_official_last_name": "ACIERNO",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "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": "IL",
            "license": "019018431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Mar 28, 2016; 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.