Provider Demographics
NPI:1134571086
Name:NOVAK, JENNIFER JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JEAN
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11644 SANDAL WOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-3000
Mailing Address - Country:US
Mailing Address - Phone:570-713-8032
Mailing Address - Fax:
Practice Address - Street 1:8350 RICHMOND HWY STE 233
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2344
Practice Address - Country:US
Practice Address - Phone:703-704-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-04
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0409171223G0001X
VA04014156011223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice