Healthcare Provider Details

I. General information

NPI: 1699323246
Provider Name (Legal Business Name): ACIERNO DENTAL SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N97W17095 DIVISION RD
GERMANTOWN WI
53022-4606
US

IV. Provider business mailing address

1699 E WOODFIELD RD STE 102
SCHAUMBURG IL
60173-4955
US

V. Phone/Fax

Practice location:
  • Phone: 262-251-1699
  • Fax:
Mailing address:
  • Phone: 330-339-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTY WOLTER
Title or Position: INSURANCE MANAGER
Credential:
Phone: 630-339-3172