Provider Demographics
NPI:1174611859
Name:NOEL, ELIZABETH M (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:NOEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:E
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8 ESTATES DRIVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-257-1990
Mailing Address - Fax:
Practice Address - Street 1:22 ARROWWOOD DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-257-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02643832Medicaid