Provider Demographics
NPI:1932251998
Name:KOVEN, L. GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:GERALD
Last Name:KOVEN
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 1:29415 BERTRAND DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4127
Mailing Address - Country:US
Mailing Address - Phone:818-264-9551
Mailing Address - Fax:818-865-8654
Practice Address - Street 1:9595 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2424
Practice Address - Country:US
Practice Address - Phone:909-624-9087
Practice Address - Fax:909-621-7547
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD22518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist