Dental Board of California
Licensing details for: 107680
Name: POUR, MACY
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
17130 Ventura Blvd #150
ENCINO CA 91316
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: EVERGREEN DENTAL AND ORTHODONTICS DENTAL PRACTICE OF BAYANI POUR DENTAL PARTNERSHIP
License/Registration Type: Fictitious Name Permit
License Number: 18233 Primary Status: Current - Active
Address :
17130 VENTURA BLVD., SUITE 150
ENCINO CA 91316
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: EVERGREEN DENTAL AND ORTHODONTICS DENTAL PRACTICE OF BAYANI POUR DENTAL PARTNERSHIP
License/Registration Type: Fictitious Name Permit
License Number: 18233 Primary Status: Current - Active
Address :
17130 VENTURA BLVD., SUITE 150
ENCINO CA 91316
LOS ANGELES COUNTY
