Provider Demographics
NPI:1467730978
Name:NOVARA, JEANETTE (DMD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:NOVARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20475 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1550
Mailing Address - Country:US
Mailing Address - Phone:305-964-8648
Mailing Address - Fax:
Practice Address - Street 1:20475 BISCAYNE BLVD
Practice Address - Street 2:G-9
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1550
Practice Address - Country:US
Practice Address - Phone:305-964-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist