Provider Demographics
NPI:1942384508
Name:NOVAK, JOSEPH BRENT (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRENT
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 1:65 CR 542W
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-4515
Mailing Address - Country:US
Mailing Address - Phone:352-569-0100
Mailing Address - Fax:352-569-0213
Practice Address - Street 1:65 CR 542W
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-4515
Practice Address - Country:US
Practice Address - Phone:352-569-0100
Practice Address - Fax:352-569-0213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDNI54631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice