MEDICARE: DR. ROY D. 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
1	1223G0001X	General Practice Dentistry	0401005839	VA

General Provider Information

NPI Number	:	1548549413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY D. NOVICK D.D.S.

Provider Business Mailing Address
First Line	:	5616G OX RD
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-1018
Country	:	US
Telephone Number	:	703-978-4746
Fax Number	:	703-978-9360

Provider Business Practice Location Address
First Line	:	5616G OX RD
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-1018
Country	:	US
Telephone Number	:	703-978-4746
Fax Number	:	703-978-9360

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

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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