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General NPI Number Information
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NPI Number | 1750503561
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Entity Type | Organization
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Legal Business Name | JOSEPSH W. NOETZEL D.D.S. AND ILENNE NOETZEL D.D.S.,LTD.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 500 ASHLAND AVE
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3091
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Country | US
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Telephone | 708-755-1333
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Fax | 708-755-2751
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Provider Business Mailing Address
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Address Line | 500 ASHLAND AVE
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3091
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Country | US
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Telephone | 708-755-1333
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Fax | 708-755-2751
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Authorized Official
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Title or Position | DDS
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Name | ILENNE NOETZEL
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Credential |
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Telephone | 708-755-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19-024540
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License Number State | IL
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