Dental Board of California
Licensing details for: 30745
Name: BLEDSOE, MARVIN RUSSELL
License Type: Dentist
Primary Status: Cancelled
Address of Record
1507 WEST YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN 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: M HOCHHALTER, DDS, B MOREHEAD, DDS, M BLEDSOE, DDS, INC
License/Registration Type: Additional Office Permit
License Number: 8173 Primary Status: Cancelled
Address :
1511 WEST YOSEMITE
MANTECA CA 95337
SAN JOAQUIN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: VALLEY OAK DENTAL GROUP M HOCHHALTER DDS
License/Registration Type: Fictitious Name Permit
License Number: 1121 Primary Status: Cancelled
Address :
B MOREHEAD DDS M BLEDSOE DDS
1507 W YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN 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: VALLEY OAK DENTAL GROUP M HOCHHALTER DDS
License/Registration Type: Fictitious Name Permit
License Number: 1121 Primary Status: Cancelled
Address :
B MOREHEAD DDS M BLEDSOE DDS
1507 W YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN 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: BLEDSOE, MARVIN RUSSELL
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 5 Primary Status: Cancelled
Address :
1507 WEST YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN COUNTY
