Healthcare Provider Details

I. General information

NPI: 1750503561
Provider Name (Legal Business Name): JOSEPSH W. NOETZEL D.D.S. AND ILENNE NOETZEL D.D.S.,LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ASHLAND AVE
CHICAGO HEIGHTS IL
60411-3091
US

IV. Provider business mailing address

500 ASHLAND AVE
CHICAGO HEIGHTS IL
60411-3091
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-1333
  • Fax: 708-755-2751
Mailing address:
  • Phone: 708-755-1333
  • Fax: 708-755-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19-024540
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ILENNE NOETZEL
Title or Position: DDS
Credential:
Phone: 708-755-1333