MEDICARE: DR. BRIAN B. NOVY 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	122300000X	Dentist	54739	CA

General Provider Information

NPI Number	:	1831221688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN B. NOVY DDS

Provider Business Mailing Address
First Line	:	1965 COULSTON ST
Second Line	:	UNIT #19
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-1740
Country	:	US
Telephone Number	:	805-573-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	22800 LYONS AVE
Second Line	:	SUITE 200
City	:	NEWHALL
State	:	CA
Zip	:	91321-6800
Country	:	US
Telephone Number	:	661-254-1884
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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