Healthcare Provider Details

I. General information

NPI: 1205957115
Provider Name (Legal Business Name): HOWARD A NOVAK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 BRIDGE STREET
RICHMOND VT
05477
US

IV. Provider business mailing address

PO BOX 43 72 BRIDGE STREET
RICHMOND VT
05477-0043
US

V. Phone/Fax

Practice location:
  • Phone: 802-434-3700
  • Fax:
Mailing address:
  • Phone: 802-434-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1069
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: