Provider Demographics
NPI:1609941293
Name:NOVAK, DANIEL THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:NOVAK
Suffix:
Gender:M
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ALUM BANK
Mailing Address - State:PA
Mailing Address - Zip Code:15521
Mailing Address - Country:US
Mailing Address - Phone:814-839-4696
Mailing Address - Fax:814-839-2177
Practice Address - Street 1:121 ROLLING ACRES DRIVE
Practice Address - Street 2:
Practice Address - City:ALUM BANK
Practice Address - State:PA
Practice Address - Zip Code:15521
Practice Address - Country:US
Practice Address - Phone:814-839-4696
Practice Address - Fax:814-839-2177
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024122L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA469981OtherBS
PA0010324840001Medicare ID - Type Unspecified