Provider Demographics
NPI:1578583498
Name:KOVAL, VICTOR (DDS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:KOVAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSSROADS DR
Mailing Address - Street 2:STE. #216
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5419
Mailing Address - Country:US
Mailing Address - Phone:410-902-0220
Mailing Address - Fax:410-902-0226
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:STE. #216
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:410-902-0220
Practice Address - Fax:410-902-0226
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice