Provider Demographics
NPI:1942422829
Name:ILENNE NOETZEL D.D.S. LTD. WILLIAM H. SLAVIN D.D.S. LTD.
Entity Type:Organization
Organization Name:ILENNE NOETZEL D.D.S. LTD. WILLIAM H. SLAVIN D.D.S. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-755-1333
Mailing Address - Street 1:20200 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1671
Mailing Address - Country:US
Mailing Address - Phone:708-755-1333
Mailing Address - Fax:708-755-2751
Practice Address - Street 1:20200 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1671
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:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0249751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER