Wheaton Prairie Dental LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

019015107 Issued in IL

Legal business name

WHEATON PRAIRIE DENTAL LLC

Practice address

610 W Roosevelt Rd
Suite A1
Wheaton, IL 60187-5087

Phone

(630) 339-3172

NPI assigned

Apr 26, 2016

Last updated

Apr 26, 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

Alan J Acierno, DDS

Title

Manager

Phone

(630) 339-3172

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461628800000",
    "number": "1619322773",
    "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": "610 W ROOSEVELT RD",
            "address_2": "SUITE A1",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601875087",
            "telephone_number": "630-339-3172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHEATON PRAIRIE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-26",
        "last_updated": "2016-04-26",
        "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_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "019029436",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "019015107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jack Whelton
• Clanisha D White

• Preferred Provider Organization in Wheaton, IL
• Providers in Wheaton, 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 Apr 26, 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.