PPD North Avenue LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PPD NORTH AVENUE LLC

Practice address

7702 W North Ave
Elmwood Park, IL 60707-4123

Phone

(630) 339-3172

Fax

(847) 891-6775

NPI assigned

Jul 1, 2013

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, D.D.S.

Title

Owner

Phone

(630) 339-3172

Specialties & licenses 1

Addresses

Other names 1

• Park Place Dental Doing business as

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

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372636800000",
    "number": "1447690789",
    "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",
            "fax_number": "847-891-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7702 W NORTH AVE",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607074123",
            "telephone_number": "630-339-3172",
            "fax_number": "847-891-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPD NORTH AVENUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-01",
        "last_updated": "2013-07-01",
        "status": "A",
        "authorized_official_last_name": "ACIERNO",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-339-3172",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Place Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; 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.