MEDICARE: REYNALDO NOVOA 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
1	1223G0001X	General Practice Dentistry	DN27949	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164115150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDO NOVOA DMD

Provider Business Mailing Address
First Line	:	4560 NW 6TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5306
Country	:	US
Telephone Number	:	786-444-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 S CYPRESS RD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-9134
Country	:	US
Telephone Number	:	954-933-1813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	10/01/2024

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