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General NPI Number Information
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NPI Number | 1700164225
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Entity Type | Organization
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Legal Business Name | JEANETTE NOVARA D.M.D., P.A.
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 20475 BISCAYNE BLVD # G-9
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City | AVENTURA
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State | FL
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Zip | 33180-1550
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Country | US
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Telephone | 305-964-8648
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Fax |
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Provider Business Mailing Address
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Address Line | 20475 BISCAYNE BLVD
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City | AVENTURA
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State | FL
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Zip | 33180-1550
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Country | US
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Telephone | 305-964-8648
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEANETTE NOVARA
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Credential | D.M.D.
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Telephone | 305-964-8648
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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 | DN19442
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License Number State | FL
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