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Individual
EZIO NOVELLI
Active
Individual
EZIO NOVELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
4301109597
MI
390200000X
Student in an Organized Health Care Education/Training Program
2901020703
MI
Other
Enumeration date
06/05/2012
Last updated
06/08/2018
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