MEDICARE: DR. JOAQUIN A. NOVOA

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	1223G0001X	General Practice Dentistry	DN0012844	FL

General Provider Information

NPI Number	:	1962666768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAQUIN A. NOVOA

Provider Business Mailing Address
First Line	:	5730 SW 74TH TER
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5308
Country	:	US
Telephone Number	:	305-665-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5730 SW 74TH TER
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5308
Country	:	US
Telephone Number	:	305-665-3115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/11/2008

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