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NPI Code Detail

MEDICARE: NICHOLAS NOVAKOVICH DMD

MEDICARE: NICHOLAS NOVAKOVICH DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist7461OK

General Provider Information

NPI Number : 1043886278
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS NOVAKOVICH DMD
Provider Business Mailing Address
First Line : 400 RIVERWALK TER STE 250
Second Line :
City : JENKS
State : OK
Zip : 74037-5619
Country : US
Telephone Number : 918-998-0996
Fax Number : 918-310-1056
Provider Business Practice Location Address
First Line : 6616 S WESTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-1708
Country : US
Telephone Number : 405-601-7852
Fax Number : 405-601-7879
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2021
Last Update Date : 05/28/2021

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Directions to “ NICHOLAS NOVAKOVICH DMD” Practice Location

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