Dental Board of California
Licensing details for: 104973
Name: MIKHAIL, ANDREW KIROLLOS
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: ANDREW MIKHAIL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81722 Primary Status: Current - Active
Address :
817 W FOOTHILL BLVD
UPLAND CA 91786
SAN BERNARDINO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: UPLAND MODERN DENTISTRY DENTAL GROUP, ANDREW MIKHAIL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18379 Primary Status: Current - Active
Address :
817 W FOOTHILL BLVD
UPLAND CA 91786
SAN BERNARDINO 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: UPLAND MODERN DENTISTRY DENTAL GROUP, ANDREW MIKHAIL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18379 Primary Status: Current - Active
Address :
817 W FOOTHILL BLVD
UPLAND CA 91786
SAN BERNARDINO COUNTY
Registered Dental Hygienist Alternative Practice to Dentist
License/Registration Role: Dentist
Related Party Role: Registered Dental Hygienist Alternative Practice
Name: Boutros, Sarah
License/Registration Type: Registered Dental Hygienist Alternative Practice
License Number: 978 Primary Status: Current - Active
Address Not Disclosed
