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Licensing details for: 19267

Name: GOLD COAST DENTAL PRACTICE OF DIANE BOVAL DDS A PROFESSIONAL DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

21050 GOLDEN SPRINGS DR., SUITE C-112
WALNUT CA 91789
LOS ANGELES county
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Practice Location

21050 GOLDEN SPRINGS DR., SUITE C-112
WALNUT CA 91789
LOS ANGELES county
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Issuance Date

January 21, 2025

Expiration Date

January 31, 2026

Current Date / Time

June 6, 2025
10:3:21 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: BOVAL, DIANE LEE

Address Not Disclosed

FNP to DDS or OMS

License/Registration Role: Fictitious Name Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: BOVAL, DIANE LEE

License/Registration Type: Dentist License

License Number: 48630 Primary Status: Current - Active

Address :
901 W Whittier Blvd
LA HABRA CA 90631-3743
ORANGE COUNTY

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