Healthcare Provider Details

I. General information

NPI: 1811344237
Provider Name (Legal Business Name): MATTHEW ALAN NOVAK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2268 N SHORE DR
RHINELANDER WI
54501-8888
US

IV. Provider business mailing address

2268 N SHORE DR
RHINELANDER WI
54501-8888
US

V. Phone/Fax

Practice location:
  • Phone: 715-420-1400
  • Fax:
Mailing address:
  • Phone: 715-420-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001402
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: