Provider Demographics
NPI:1538542279
Name:NAVOA, NORRIS P (DMD)
Entity type:Individual
Prefix:
First Name:NORRIS
Middle Name:P
Last Name:NAVOA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SCHILLER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60176-1112
Mailing Address - Country:US
Mailing Address - Phone:773-313-7014
Mailing Address - Fax:
Practice Address - Street 1:9535 SW 187TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7861
Practice Address - Country:US
Practice Address - Phone:773-313-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030233122300000X
FLDN21721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist