Provider Demographics
NPI:1801310420
Name:NOELCK, FORREST JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:JAMES
Last Name:NOELCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 E CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3750
Mailing Address - Country:US
Mailing Address - Phone:623-451-1084
Mailing Address - Fax:
Practice Address - Street 1:551 E PLAZA CIR STE C
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4923
Practice Address - Country:US
Practice Address - Phone:623-935-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ98121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice