Dental Board of California
Licensing details for: 102465
Name: RUSSIKOFF, GARRETT MATTHEW
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: WOODSTONE PLAZA DENTAL, A PRACTICE OF GARRETT RUSSIKOFF, D.M.D., INC.
License/Registration Type: Fictitious Name Permit
License Number: 15076 Primary Status: Current - Active
Address :
18911 NORDHOFF ST. SUITE 35
NORTHRIDGE CA 91324
LOS ANGELES 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: RUSSIKOFF FAMILY DENTISTRY DENTAL OFFICE OF GARRETT RUSSIKOFF
License/Registration Type: Fictitious Name Permit
License Number: 15076 Primary Status: Current - Active
Address :
18911 NORDHOFF ST. SUITE 35
NORTHRIDGE CA 91324
LOS ANGELES COUNTY
Registered Dental Hygienist Alternative Practice to Dentist
License/Registration Role: Dentist
Related Party Role: Registered Dental Hygienist Alternative Practice
Name: KINNE, ERIN DOREENA
License/Registration Type: Registered Dental Hygienist Alternative Practice
License Number: 1076 Primary Status: Current - Active
Address Not Disclosed
