Provider Demographics
NPI:1194832824
Name:NOVAK, TIMOTHY STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:STEPHEN
Last Name:NOVAK
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 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-8665
Mailing Address - Fax:262-547-4328
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 222
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-547-8665
Practice Address - Fax:262-547-4328
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10571OtherDEANCARE HMO
WI33709900Medicaid
WI2011072002OtherCIGNA MEDICAL
WI759310OtherUNITED CONCORDIA DENTAL
WI1008606OtherPHYSICIANS PLUS
WI10571OtherDEANCARE HMO