Provider Demographics
NPI:1962666768
Name:NOVOA, JOAQUIN A
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:A
Last Name:NOVOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00128441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice