MEDICARE: DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	37769	CA

General Provider Information

NPI Number	:	1538609243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP

Provider Business Mailing Address
First Line	:	901 W WHITTIER BLVD
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-3743
Country	:	US
Telephone Number	:	562-356-0948
Fax Number	:	866-817-3581

Provider Business Practice Location Address
First Line	:	275 CENTENNIAL WAY STE 109
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3708
Country	:	US
Telephone Number	:	714-795-3882
Fax Number	:	714-729-8748

Authorized Official
Title or Position	:	CEO
Name	:	ALAN BOVAL
Credential	:
Telephone Number	:	562-905-8338

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	03/28/2026

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