Dental Board of California
Licensing details for: 100398
Name: GOLLA, KEERTHI
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by Credential
Address of Record
52 Verde Way
FREMONT CA 94539-2206
ALAMEDA county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: REDWOOD SMILES, DENTAL PRACTICE OF KEERTHI GOLLA, DMD, INCORPORATED
License/Registration Type: Fictitious Name Permit
License Number: 14192 Primary Status: Expired
Address :
160 BIRCH ST STE A
REDWOOD CITY CA 94062
SAN MATEO COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: REDWOOD SMILES, DENTAL PRACTICE OF KEERTHI GOLLA, DMD, INCORPORATED
License/Registration Type: Fictitious Name Permit
License Number: 14192 Primary Status: Expired
Address :
160 BIRCH ST STE A
REDWOOD CITY CA 94062
SAN MATEO COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: GOLLA, KEERTHI
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 3566 Primary Status: Cancelled
Address :
160 Birch St Ste A
REDWOOD CITY CA 94062-1307
SAN MATEO COUNTY
