Healthcare Provider Details

I. General information

NPI: 1841007572
Provider Name (Legal Business Name): AARON JACOB NOWAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 JASMINE WAY
CLEARWATER FL
33756-4086
US

IV. Provider business mailing address

14100 58TH ST N STE 100
CLEARWATER FL
33760-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax:
Mailing address:
  • Phone: 727-333-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: