Healthcare Provider Details

I. General information

NPI: 1376983684
Provider Name (Legal Business Name): MICHAEL A. ACIERNO, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6749 N OSHKOSH AVE
CHICAGO IL
60631-1162
US

IV. Provider business mailing address

6749 N OSHKOSH AVE
CHICAGO IL
60631-1162
US

V. Phone/Fax

Practice location:
  • Phone: 630-339-3172
  • Fax: 847-891-6775
Mailing address:
  • Phone: 630-339-3172
  • Fax: 847-891-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL A. ACIERNO
Title or Position: OWNER
Credential: D.D.S.
Phone: 630-339-3172