MEDICARE: DANIEL NICHOLAS NOVELLA 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	DN27282	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992439525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL NICHOLAS NOVELLA DDS

Provider Business Mailing Address
First Line	:	600 TECHNOLOGY PARK STE 101
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-7122
Country	:	US
Telephone Number	:	800-786-1613
Fax Number	:

Provider Business Practice Location Address
First Line	:	4969 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3657
Country	:	US
Telephone Number	:	863-614-0044
Fax Number	:	863-272-7566

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

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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