MEDICARE: DR. JOAQUIN J. NOVOA SR. 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	DN4931	FL

General Provider Information

NPI Number	:	1366681447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAQUIN J. NOVOA SR. DDS

Provider Business Mailing Address
First Line	:	5730 SW 74TH TER
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5308
Country	:	US
Telephone Number	:	305-665-3115
Fax Number	:	305-665-3114

Provider Business Practice Location Address
First Line	:	5730 SW 74TH TER
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5308
Country	:	US
Telephone Number	:	305-665-3115
Fax Number	:	305-665-3114

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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