Provider Demographics
NPI:1801235650
Name:NOVAK, DANIEL T JR (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:NOVAK
Suffix:JR
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 1:1699 ADAMS RUN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:PA
Mailing Address - Zip Code:15554-8809
Mailing Address - Country:US
Mailing Address - Phone:814-341-4632
Mailing Address - Fax:814-839-2908
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:BUILDING D, SUITE D-103
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-889-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist