Provider Demographics
NPI:1548549413
Name:NOVICK, ROY D (DDS)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:D
Last Name:NOVICK
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 1:5616G OX RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1018
Mailing Address - Country:US
Mailing Address - Phone:703-978-4746
Mailing Address - Fax:703-978-9360
Practice Address - Street 1:5616G OX RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1018
Practice Address - Country:US
Practice Address - Phone:703-978-4746
Practice Address - Fax:703-978-9360
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice