Provider Demographics
NPI:1508479460
Name:HOUCK-MCKENNEY, NOELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:
Last Name:HOUCK-MCKENNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:
Other - Last Name:HOUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4158 N BAINSBURY DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9496
Mailing Address - Country:US
Mailing Address - Phone:208-705-4150
Mailing Address - Fax:
Practice Address - Street 1:1959 COMMERCE CENTER CIR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-7419
Practice Address - Country:US
Practice Address - Phone:287-718-1669
Practice Address - Fax:928-445-3698
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD51911223G0001X
UT12460588-99211223G0001X
AZD0107451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice