Route 64 Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019012964 Issued in IL

Legal business name

ROUTE 64 DENTAL LLC

Practice address

306 W Main St
St Charles, IL 60174-1814

Phone

(630) 584-6177

NPI assigned

Aug 31, 2017

Organization subpart

No

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

Authorized official

Name

Alan M Acierno

Title

Cfo

Phone

(630) 339-3172

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John F. Micka, D.D.S.

  • Dentist
  • St Charles, IL
  • NPI 1164614061
  NPD (past)

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

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504137600000",
    "number": "1508384355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1699 E WOODFIELD RD STE 102",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734955",
            "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": "306 W MAIN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741814",
            "telephone_number": "630-584-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUTE 64 DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2017-08-31",
        "status": "A",
        "authorized_official_last_name": "ACIERNO",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "630-339-3172"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019015977",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019012964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Lee Rosas, LSW
• Jake Rosenfeldt
• Rosewood Care Center, Inc of St Charles
• Jennifer Lee Ross, LCSW
• Staci M Roth, OTR
• Royalnova Healthcare
• Magdalena Rozycki, MSW
• Anna Linnea Rucinova, MA, ALMFT
• Anna Ruffalo, RBT
• Nevin Jai Runge

• General Practice Dentistry in St Charles, IL
• Providers in St Charles, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2017; 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.