Provider Demographics
NPI:1093262420
Name:NOVOTNY, ANNIE (RDH)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:SORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:6625 HOFFERBER RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MT
Mailing Address - Zip Code:59079-4320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6625 HOFFERBER RD
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MT
Practice Address - Zip Code:59079-4320
Practice Address - Country:US
Practice Address - Phone:406-202-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11512124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist