Provider Demographics
NPI:1992013825
Name:NOVAK, IRINA V (DMD)
Entity type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:V
Last Name:NOVAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 GEORGE WASHINGTON MEMORIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692
Mailing Address - Country:US
Mailing Address - Phone:757-898-6788
Mailing Address - Fax:757-898-1042
Practice Address - Street 1:4326 GEORGE WASHINGTON MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692
Practice Address - Country:US
Practice Address - Phone:757-898-6788
Practice Address - Fax:757-898-1042
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014128491223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice