California
Department of Consumer Affairs
DOCTOR RELATIONS
Dental - Registered Provider
License number
4431
Date granted
06/23/2006
Date expires
06/30/2010
Class
Dental - Registered Provider
Status
Delinquent
Address
CANOGA PARK
californialicensing.org
ID 19811746
LAST UPDATED 2026-05-09 05:29:31 UTC
LAST UPDATED 2026-05-09 05:29:31 UTC
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