Provider Demographics
NPI:1871645903
Name:NOVASACK, GEORGE FRANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FRANK
Last Name:NOVASACK
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 1:560 SHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-927-5454
Mailing Address - Fax:609-927-6369
Practice Address - Street 1:560 SHORE ROAD
Practice Address - Street 2:
Practice Address - City:SAMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-927-5454
Practice Address - Fax:609-927-6369
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist