Dental Board of California
Licensing details for: 102782
Name: RATANATHARATHORN, KIATKACHORN
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
2420 S Azusa Ave
WEST COVINA CA 91792-1512
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: Kiatkachorn Ratanatharathorn, DDS Inc
License/Registration Type: Fictitious Name Permit
License Number: 17993 Primary Status: Current - Active
Address :
2420 S AZUSA AVE
WEST COVINA CA 91792-1512
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: NU DENTAL PRACTICE OF KIATKACHORN RATANATHARATHORN, DDS INC
License/Registration Type: Fictitious Name Permit
License Number: 17993 Primary Status: Current - Active
Address :
2420 S AZUSA AVE
WEST COVINA CA 91792-1512
LOS ANGELES COUNTY
