Provider Demographics
NPI:1407489446
Name:JOSEPH R CEISEL DDS PC
Entity Type:Organization
Organization Name:JOSEPH R CEISEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-256-4270
Mailing Address - Street 1:423 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2826
Mailing Address - Country:US
Mailing Address - Phone:847-421-3181
Mailing Address - Fax:
Practice Address - Street 1:423 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2826
Practice Address - Country:US
Practice Address - Phone:847-421-3181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment