MEDICARE: JOSEPSH W. NOETZEL D.D.S. AND ILENNE NOETZEL D.D.S.,LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry	19-024540	IL

General Provider Information

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

Provider Business Mailing Address
First Line	:	500 ASHLAND AVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3091
Country	:	US
Telephone Number	:	708-755-1333
Fax Number	:	708-755-2751

Provider Business Practice Location Address
First Line	:	500 ASHLAND AVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3091
Country	:	US
Telephone Number	:	708-755-1333
Fax Number	:	708-755-2751

Authorized Official
Title or Position	:	DDS
Name	:	ILENNE NOETZEL
Credential	:
Telephone Number	:	708-755-1333

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/18/2023

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