Provider Demographics
NPI:1881163004
Name:ADRIAN ACOSTA DDS A PROF DENTAL CORP
Entity type:Organization
Organization Name:ADRIAN ACOSTA DDS A PROF DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-552-1344
Mailing Address - Street 1:901 W. WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631
Mailing Address - Country:US
Mailing Address - Phone:562-905-8338
Mailing Address - Fax:
Practice Address - Street 1:901 W. WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:562-905-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADRIAN ACOSTA DDS A PROF DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty