Provider Demographics
NPI:1578960506
Name:JOAQUIN NOVOA
Entity Type:Organization
Organization Name:JOAQUIN NOVOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVOA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-665-3115
Mailing Address - Street 1:5730 SW 74TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5308
Mailing Address - Country:US
Mailing Address - Phone:305-665-3115
Mailing Address - Fax:
Practice Address - Street 1:5730 SW 74TH TER
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5308
Practice Address - Country:US
Practice Address - Phone:305-665-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty