Provider Demographics
NPI:1467866327
Name:NOVAK, HEIDI (DDS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 PACKARD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3874
Mailing Address - Country:US
Mailing Address - Phone:734-761-3116
Mailing Address - Fax:
Practice Address - Street 1:1303 PACKARD ST STE 101
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3874
Practice Address - Country:US
Practice Address - Phone:734-761-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021227122300000X, 1223X0400X
OH30.0271091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist