=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801310420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FORREST JAMES NOELCK DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2017
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 551 E PLAZA CIR STE C
-----------------------------------------------------
City | LITCHFIELD PARK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85340-4923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-935-1158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3511 E CLAREMONT AVE
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-451-1084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 9812
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------