Dental Board of California
Licensing details for: 103690
Name: MYLAD, BOTAMENA M
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: MYLAD DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81681 Primary Status: Current - Active
Address :
24119 HEMLOCK AVENUE, SUITE 108
MORENO VALLEY CA 92557
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MORENO VALLEY MODERN DENTISTRY DENTAL GROUP, MYLAD DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18279 Primary Status: Current - Active
Address :
24119 HEMLOCK AVENUE, SUITE 108
MORENO VALLEY CA 92557
RIVERSIDE 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: MORENO VALLEY MODERN DENTISTRY DENTAL GROUP, MYLAD DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18279 Primary Status: Current - Active
Address :
24119 HEMLOCK AVENUE, SUITE 108
MORENO VALLEY CA 92557
RIVERSIDE 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: MYLAD, BOTAMENA M
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 4515 Primary Status: Current - Active
Address :
24119 Hemlock Ave
Ste 108
MORENO VALLEY CA 92557-7220
