Dental Board of California
Licensing details for: 28872
Name: KETCHERSIDE, HOMER GARY
License Type: Dentist
Primary Status: Current - Active
Address of Record
400 W Stuart AVe
ste.110
REDLANDS CA 92374
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: KETCHERSIDE DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80421 Primary Status: Current - Active
Address :
400 W Stuart Ave
Suite 110
REDLANDS CA 92374-3126
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: THE BRACE CONNECTION DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1104 Primary Status: Cancelled
Address :
1468 INDUSTRIAL PARK DRIVE
REDLANDS CA 92373
SAN BERNARDINO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PACKING HOUSE DENTAL AND ORTHODONTICS DENTAL PRACTICE OF KETCHERSIDE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15533 Primary Status: Current - Active
Address :
400 W STUART AVE, SUITE #110
REDLANDS CA 92374
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: THE BRACE CONNECTION DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1104 Primary Status: Cancelled
Address :
1468 INDUSTRIAL PARK DRIVE
REDLANDS CA 92373
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: PACKING HOUSE DENTAL AND ORTHODONTICS DENTAL PRACTICE OF KETCHERSIDE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15533 Primary Status: Current - Active
Address :
400 W STUART AVE, SUITE #110
REDLANDS CA 92374
SAN BERNARDINO COUNTY
