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General NPI Number Information
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NPI Number | 1073205258
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Entity Type | Individual
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Provider Name | THEODORE D NOVAK III DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 419 OLD ELKHART RD STE 110
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City | PALESTINE
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State | TX
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Zip | 75801-6047
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Country | US
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Telephone | 903-723-4669
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 N INTERSTATE 35 STE 205
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City | DENTON
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State | TX
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Zip | 76207-1438
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Country | US
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Telephone | 940-220-7833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41113
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 110457
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License Number State | CA
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