Meadow Lake Dental LLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

019021506 Issued in IL

Legal business name

MEADOW LAKE DENTAL LLC

Practice address

3941 75TH St
Suite 102
Aurora, IL 60504-7924

Phone

(630) 851-5130

Fax

(630) 851-5739

NPI assigned

Sep 7, 2014

Organization subpart

Yes

Parent organization

ACIERNO DENTAL, LLCAs reported in NPPES

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 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1410048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410048000000",
    "number": "1972904282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 S ROSELLE RD STE 102",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601935538",
            "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": "3941 75TH ST",
            "address_2": "SUITE 102",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047924",
            "telephone_number": "630-851-5130",
            "fax_number": "630-851-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW LAKE DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACIERNO DENTAL, LLC",
        "enumeration_date": "2014-09-07",
        "last_updated": "2014-09-07",
        "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": "019021506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1144341108",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cathy McMillan, PTA
• Denika McMillen, LCSW
• Michelle Marie McMullin, L.C.P.C.
• Darryl John McNeil, PT,MTC
• Meadow Lake Dental Care P.C.
• Meals Delivered With Care
• Christina Mecca, M.A., CCC-SLP
• Medical Care Associates Inc
• Medlab Professionals LLC
• Medshop Pharmacy LLC

• Preferred Provider Organization in Aurora, IL
• Providers in Aurora, 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 7, 2014; 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.