Provider Demographics
NPI:1063594463
Name:NOVAK, JEFFREY M (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:NOVAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 38TH ST. SUITE E-4
Mailing Address - Street 2:AIDS SERVICES OF AUSTIN
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-479-6633
Mailing Address - Fax:512-479-6617
Practice Address - Street 1:711 W 38TH ST. SUITE E-4
Practice Address - Street 2:AIDS SERVICES OF AUSTIN
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-479-6633
Practice Address - Fax:512-479-6617
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161812601Medicaid