Provider Demographics
NPI:1154102531
Name:DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP
Entity type:Organization
Organization Name:DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-356-0948
Mailing Address - Street 1:901 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3743
Mailing Address - Country:US
Mailing Address - Phone:562-356-0948
Mailing Address - Fax:866-817-3581
Practice Address - Street 1:10149 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-1454
Practice Address - Country:US
Practice Address - Phone:562-356-0948
Practice Address - Fax:866-817-3581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIANE BOVAL DDS A PROFESSIONAL DENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty