Healthcare Provider Details

I. General information

NPI: 1407489446
Provider Name (Legal Business Name): JOSEPH R CEISEL DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 4TH ST
WILMETTE IL
60091-2826
US

IV. Provider business mailing address

423 4TH ST
WILMETTE IL
60091-2826
US

V. Phone/Fax

Practice location:
  • Phone: 847-421-3181
  • Fax:
Mailing address:
  • Phone: 847-421-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH R CEISEL
Title or Position: OWNER
Credential: DDS
Phone: 847-256-4270