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General NPI Number Information
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NPI Number | 1871904581
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH NOVAK D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 5651 NAPLES BLVD
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City | NAPLES
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State | FL
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Zip | 34109-2023
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Country | US
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Telephone | 239-839-5985
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Fax |
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Provider Business Mailing Address
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Address Line | 3581 7TH AVE SW
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City | NAPLES
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State | FL
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Zip | 34117-4147
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Country | US
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Telephone | 239-269-0233
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN20711
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN20711
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License Number State | FL
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