Provider Demographics
NPI:1033289780
Name:NOVACK, NEAL M (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:M
Last Name:NOVACK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-0681
Mailing Address - Country:US
Mailing Address - Phone:508-829-2642
Mailing Address - Fax:508-829-2618
Practice Address - Street 1:1092 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1247
Practice Address - Country:US
Practice Address - Phone:508-829-2642
Practice Address - Fax:508-829-2618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice