Provider Demographics
NPI:1750503561
Name:JOSEPSH W. NOETZEL D.D.S. AND ILENNE NOETZEL D.D.S.,LTD.
Entity Type:Organization
Organization Name:JOSEPSH W. NOETZEL D.D.S. AND ILENNE NOETZEL D.D.S.,LTD.
Other - Org Name:ASHLAND DENTAL AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:ILENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-755-1333
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0245401223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty