Provider Demographics
NPI:1841447190
Name:JOSEPH BRENT NOVAK, DMD,PA
Entity type:Organization
Organization Name:JOSEPH BRENT NOVAK, DMD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-569-0100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177941223E0200X
FLDN152061223G0001X
FLDN142461223G0001X
FLDN169131223S0112X
FLDN154631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty