Provider Demographics
NPI:1417152612
Name:NOVOA, CALIXTO II
Entity Type:Individual
Prefix:DR
First Name:CALIXTO
Middle Name:
Last Name:NOVOA
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8372 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3355
Mailing Address - Country:US
Mailing Address - Phone:305-552-8033
Mailing Address - Fax:305-552-9194
Practice Address - Street 1:8372 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3355
Practice Address - Country:US
Practice Address - Phone:305-552-8033
Practice Address - Fax:305-552-9194
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0131391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice