Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 08064 | IA |
NPI | 1023144185 |
---|---|
Provider Name | Brady A Novak |
First Address | Cedar Rapids, IA 52403-2442 |
Second Address | Cedar Rapids, IA 52403-2442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2007 |
Last Update Date | 08/07/2007 |