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General NPI Number Information
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NPI Number | 1891272910
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Entity Type | Individual
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Provider Name | JOSE ANTONIO NOVOA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2018
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Last Update Date | 07/21/2018
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Provider Practice Location Address
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Address Line | 9280 SW 72ND ST STE 101
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City | MIAMI
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State | FL
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Zip | 33173-3240
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Country | US
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Telephone | 786-385-8577
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Fax |
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Provider Business Mailing Address
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Address Line | 9775 SW 125TH AVE
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City | MIAMI
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State | FL
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Zip | 33186-2434
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Country | US
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Telephone | 786-385-8577
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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 | 23714
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License Number State | FL
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