Provider Demographics
NPI:1174630206
Name:NOWAK, JEFFREY S (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:NOWAK
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 1:10752 N 89TH PLACE
Mailing Address - Street 2:SUITE 107 JEFFREY S NOWAK DDS
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-860-9518
Mailing Address - Fax:480-860-8934
Practice Address - Street 1:10752 N 89TH PLACE
Practice Address - Street 2:SUITE 107 JEFFREY S NOWAK DDS
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-860-9518
Practice Address - Fax:480-860-8934
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice