Healthcare Provider Details

I. General information

NPI: 1174900013
Provider Name (Legal Business Name): PROGRESSIVE DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PYOTT RD SUITE 209
LAKE IN THE HILLS IL
60156-9794
US

IV. Provider business mailing address

129 S ROSELLE RD SUITE 102
SCHAUMBURG IL
60193-5540
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number019028928
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number019028439
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number019028070
License Number StateIL

VIII. Authorized Official

Name: DR. ALAN J ACIERNO
Title or Position: MANAGER
Credential: D.D.S.
Phone: 630-339-3172