Provider Demographics
NPI:1407175227
Name:NOVARK, BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:NOVARK
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 1:2355 STANFORD CT UNIT 701
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-4813
Mailing Address - Country:US
Mailing Address - Phone:239-566-7425
Mailing Address - Fax:239-593-3430
Practice Address - Street 1:2355 STANFORD CT UNIT 701
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4813
Practice Address - Country:US
Practice Address - Phone:239-566-7425
Practice Address - Fax:239-593-3430
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 18507OtherDENTAL LICENSE