Provider Demographics
NPI:1073735932
Name:NOETZEL, ILENNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ILENNE
Middle Name:
Last Name:NOETZEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3091
Mailing Address - Country:US
Mailing Address - Phone:708-755-1333
Mailing Address - Fax:708-755-2751
Practice Address - Street 1:500 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3091
Practice Address - Country:US
Practice Address - Phone:708-755-1333
Practice Address - Fax:708-755-2751
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0249751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice