Healthcare Provider Details

I. General information

NPI: 1093646671
Provider Name (Legal Business Name): DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8748 CORBIN AVE
NORTHRIDGE CA
91324-3307
US

IV. Provider business mailing address

901 W WHITTIER BLVD
LA HABRA CA
90631-3743
US

V. Phone/Fax

Practice location:
  • Phone: 213-246-4490
  • Fax: 866-817-3581
Mailing address:
  • Phone: 714-421-4952
  • Fax: 562-352-8956

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