Provider Demographics
NPI:1841208337
Name:NOVOTNY, DONALD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOHN
Last Name:NOVOTNY
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 1:203 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1432
Mailing Address - Country:US
Mailing Address - Phone:419-433-5135
Mailing Address - Fax:419-433-5934
Practice Address - Street 1:3307 CLEVELAND RD W
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1021
Practice Address - Country:US
Practice Address - Phone:419-433-5013
Practice Address - Fax:419-433-5934
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300157871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice