| Northern Dental General And Cosmetic Dentistry Llc | |
|
5651 Naples Blvd Naples FL 34109-2023 | |
| (239) 431-5666 | |
| Not Available |
| Full Name | Northern Dental General And Cosmetic Dentistry Llc |
|---|---|
| Speciality | Dentist |
| Location | 5651 Naples Blvd, Naples, Florida |
| Authorized Official Name and Position | Shannon Novak (MANAGER) |
| Authorized Official Contact | 2394315666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Dental General And Cosmetic Dentistry Llc 5651 Naples Blvd Naples FL 34109-2023 Ph: () - | Northern Dental General And Cosmetic Dentistry Llc 5651 Naples Blvd Naples FL 34109-2023 Ph: (239) 431-5666 |
| NPI Number | 1164877395 |
|---|---|
| Provider Enumeration Date | 04/25/2016 |
| Last Update Date | 04/25/2016 |
| Medicare PECOS PAC ID | 2668800962 |
|---|---|
| Medicare Enrollment ID | O20200325002673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164877395 | NPI | - | NPPES |
| 016807000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN20711 (Florida) | Primary |
| Provider Name | Shannon E Novak |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1871904581 PECOS PAC ID: 6204133317 Enrollment ID: I20200320000433 |
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