Provider Demographics
NPI:1235638594
Name:LORENE CATALA BOISVERT D.D.S., P.C.
Entity Type:Organization
Organization Name:LORENE CATALA BOISVERT D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:CATALA
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-310-4696
Mailing Address - Street 1:10850 WILSHIRE BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4708
Mailing Address - Country:US
Mailing Address - Phone:310-310-4696
Mailing Address - Fax:323-694-5251
Practice Address - Street 1:10850 WILSHIRE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4708
Practice Address - Country:US
Practice Address - Phone:310-310-4696
Practice Address - Fax:323-694-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty