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NPI Code Detail

MEDICARE: DR. RICHARD NOVICK D.D.S.

MEDICARE: DR. RICHARD NOVICK D.D.S.
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry10436TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S3-62COTHERNVSTATE BOARD OF DENTAL EXAMINERS

General Provider Information

NPI Number : 1447252671
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD NOVICK D.D.S.
Provider Business Mailing Address
First Line : 51 SUN POINT LN
Second Line :
City : EL PASO
State : TX
Zip : 79912-4262
Country : US
Telephone Number : 915-472-1115
Fax Number :
Provider Business Practice Location Address
First Line : 2260 TRAWOOD DR
Second Line :
City : EL PASO
State : TX
Zip : 79935-3040
Country : US
Telephone Number : 915-591-6676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 03/17/2014

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