Healthcare Provider Details

I. General information

NPI: 1285574939
Provider Name (Legal Business Name): DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N SAN FERNANDO BLVD
BURBANK CA
91504-4331
US

IV. Provider business mailing address

901 W WHITTIER BLVD
LA HABRA CA
90631-3743
US

V. Phone/Fax

Practice location:
  • Phone: 562-356-0948
  • Fax:
Mailing address:
  • Phone: 562-352-0397
  • Fax: 562-265-1574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALAN BOVAL
Title or Position: CEO
Credential:
Phone: 562-905-8338