Provider Demographics
NPI:1629168265
Name:DOVIGI, ALLAN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JOSEPH
Last Name:DOVIGI
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 1:9520 CHESAPEAKE DR
Mailing Address - Street 2:SUITE 607
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1331
Mailing Address - Country:US
Mailing Address - Phone:800-955-4765
Mailing Address - Fax:
Practice Address - Street 1:9520 CHESAPEAKE DR
Practice Address - Street 2:SUITE 607
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1331
Practice Address - Country:US
Practice Address - Phone:800-955-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70841223P0106X
CA600851223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology