MEDICARE: MARK R NOVELEN DDS

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	104944	CO

General Provider Information

NPI Number	:	1245329770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK R NOVELEN DDS

Provider Business Mailing Address
First Line	:	3627 S PENNSYLVANIA ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3753
Country	:	US
Telephone Number	:	303-781-0624
Fax Number	:	303-781-9551

Provider Business Practice Location Address
First Line	:	3627 S PENNSYLVANIA ST
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-3753
Country	:	US
Telephone Number	:	303-781-0624
Fax Number	:	303-781-9551

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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