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General NPI Number Information
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NPI Number | 1548549413
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Entity Type | Individual
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Provider Name | ROY D. NOVICK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 5616G OX RD
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-1018
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Country | US
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Telephone | 703-978-4746
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Fax | 703-978-9360
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Provider Business Mailing Address
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Address Line | 5616G OX RD
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-1018
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Country | US
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Telephone | 703-978-4746
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Fax | 703-978-9360
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401005839
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License Number State | VA
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