Provider Demographics
NPI:1063564680
Name:NOVAK, THOMAS J (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 S WACO ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4308
Mailing Address - Country:US
Mailing Address - Phone:817-594-7302
Mailing Address - Fax:817-599-7191
Practice Address - Street 1:326 S WACO ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4308
Practice Address - Country:US
Practice Address - Phone:817-594-7302
Practice Address - Fax:817-599-7191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice