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General NPI Number Information
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NPI Number | 1285025213
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Entity Type | Organization
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Legal Business Name | LAWRENCE PLAZA DENTAL LLC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 129 S ROSELLE RD SUITE 102
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City | SCHAUMBURG
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State | IL
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Zip | 60193-5540
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Country | US
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Telephone | 630-339-3172
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Fax | 847-339-3172
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Provider Business Mailing Address
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Address Line | 5912 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ALAN J ACIERNO
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Credential | DDS
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Telephone | 630-339-3172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 019027347
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 019018205
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 019016834
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 01905148
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License Number State | IL
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