Provider Demographics
NPI:1740334036
Name:NOVY, CHARLES KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:NOVY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:NOVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:SUITE J-203
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-327-5977
Mailing Address - Fax:512-327-5979
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:SUITE J-203
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-327-5977
Practice Address - Fax:512-327-5979
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743011269OtherTAX IDENTIFCATION NUMBER