Provider Demographics
NPI:1477699916
Name:NOVICK, GERALD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:R
Last Name:NOVICK
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 1:85 ELLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5220
Mailing Address - Country:US
Mailing Address - Phone:925-825-9285
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:1821 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2348
Practice Address - Country:US
Practice Address - Phone:925-825-9285
Practice Address - Fax:174-571-3560
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD19791Medicaid