MEDICARE: EVAN NOVICK DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	10443	NC

General Provider Information

NPI Number	:	1952891921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVAN NOVICK DMD PA

Provider Business Mailing Address
First Line	:	1619 EMORY OAK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-9813
Country	:	US
Telephone Number	:	781-248-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 RANDOLPH RD STE 101
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1067
Country	:	US
Telephone Number	:	704-366-3452
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVAN NOVICK
Credential	:	DMD
Telephone Number	:	781-248-3493

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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