Provider Demographics
NPI:1619317922
Name:CARY GROVE DENTAL LLC
Entity type:Organization
Organization Name:CARY GROVE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACIERNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-339-3172
Mailing Address - Street 1:129 S ROSELLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5540
Mailing Address - Country:US
Mailing Address - Phone:630-339-3172
Mailing Address - Fax:847-891-6775
Practice Address - Street 1:2615 THREE OAKS RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6127
Practice Address - Country:US
Practice Address - Phone:630-339-3172
Practice Address - Fax:847-891-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty