Healthcare Provider Details

I. General information

NPI: 1538609243
Provider Name (Legal Business Name): DIANE BOVAL DDS A PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CENTENNIAL WAY STE 109
TUSTIN CA
92780-3708
US

IV. Provider business mailing address

901 W WHITTIER BLVD
LA HABRA CA
90631-3743
US

V. Phone/Fax

Practice location:
  • Phone: 714-795-3882
  • Fax: 714-729-8748
Mailing address:
  • Phone: 562-356-0948
  • Fax: 866-817-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37769
License Number StateCA

VIII. Authorized Official

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