Provider Demographics
NPI:1871904581
Name:NOVAK, SHANNON ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELIZABETH
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 1:3581 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-4147
Mailing Address - Country:US
Mailing Address - Phone:239-269-0233
Mailing Address - Fax:
Practice Address - Street 1:5651 NAPLES BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2023
Practice Address - Country:US
Practice Address - Phone:239-839-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20711122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist