Provider Demographics
NPI:1952653206
Name:NOVAS, TATIANA (DMD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:NOVAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 OCEAN PKWY
Mailing Address - Street 2:APT 16P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8200
Mailing Address - Country:US
Mailing Address - Phone:401-965-8828
Mailing Address - Fax:
Practice Address - Street 1:2940 OCEAN PKWY
Practice Address - Street 2:APT 16P
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8200
Practice Address - Country:US
Practice Address - Phone:401-965-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0564231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice