Provider Demographics
NPI:1740888486
Name:KOVAL, SVITLANA (DMD, MSC, BDS)
Entity type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:KOVAL
Suffix:
Gender:F
Credentials:DMD, MSC, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 NW 115TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4239
Mailing Address - Country:US
Mailing Address - Phone:954-600-2056
Mailing Address - Fax:
Practice Address - Street 1:1905 CLINT MOORE RD STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2660
Practice Address - Country:US
Practice Address - Phone:954-600-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN255131223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist