Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 08606 | MI |
NPI | 1023153517 |
---|---|
Provider Name | Dr. Marvin Novetsky |
First Address | Farmington Hills, MI 48334-3342 |
Second Address | Farmington Hills, MI 48334-3342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |