Healthcare Provider Details

I. General information

NPI: 1154247633
Provider Name (Legal Business Name): PETER MICHAEL NOVOTNY JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 125
SANDERS AZ
86512-0125
US

IV. Provider business mailing address

16055 SIMS RD APT 104
DELRAY BEACH FL
33484-6312
US

V. Phone/Fax

Practice location:
  • Phone: 928-688-5600
  • Fax:
Mailing address:
  • Phone: 561-212-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: