Provider Demographics
NPI:1699323246
Name:ACIERNO DENTAL SC
Entity type:Organization
Organization Name:ACIERNO DENTAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-339-3172
Mailing Address - Street 1:1699 E WOODFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4955
Mailing Address - Country:US
Mailing Address - Phone:330-339-3172
Mailing Address - Fax:
Practice Address - Street 1:N97W17095 DIVISION RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4606
Practice Address - Country:US
Practice Address - Phone:262-251-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACIERNO DENTAL SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental