Dental Board of California
Licensing details for: 27842
Name: SUPRONO, MAVERN SERMIN
License Type: Dentist
Primary Status: Expired
Address of Record
P.O. BOX 13218
SAN BERNARDINO CA 92423
SAN BERNARDINO county
Map
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: MAVERN SUPRONO DDS INC
License/Registration Type: Additional Office Permit
License Number: 5358 Primary Status: Cancelled
Address :
1080 EAST WASHINGTON
SUITE B
COLTON CA 91324
SAN BERNARDINO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: DENTAL ASSOCIATES OF POMONA
License/Registration Type: Fictitious Name Permit
License Number: 1392 Primary Status: Cancelled
Address :
OFFICE OF DR M SUPRONO
180 EAST MISSION BLVD
POMONA CA 91766
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: DENTAL ASSOCIATES OF COLTON
License/Registration Type: Fictitious Name Permit
License Number: 1391 Primary Status: Expired
Address :
OFFICE OF DR M SUPRONO
1080 EAST WSHINGTON STREET, SUITE B
COLTON CA 92324
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: DENTAL ASSOCIATES OF COLTON
License/Registration Type: Fictitious Name Permit
License Number: 1391 Primary Status: Expired
Address :
OFFICE OF DR M SUPRONO
1080 EAST WSHINGTON STREET, SUITE B
COLTON CA 92324
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: DENTAL ASSOCIATES OF POMONA
License/Registration Type: Fictitious Name Permit
License Number: 1392 Primary Status: Cancelled
Address :
OFFICE OF DR M SUPRONO
180 EAST MISSION BLVD
POMONA CA 91766
LOS ANGELES COUNTY
