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Licensing details for: 40030

Name: THIO, YURITA HARTOJO

License Type: Dentist

Primary Status: Expired Primary Status Definition

Address of Record

4428 Arcola Ave
TOLUCA LAKE CA 91602-2417
LOS ANGELES county
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Practice Location

4428 Arcola Ave
TOLUCA LAKE CA 91602
LOS ANGELES county
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Issuance Date

April 30, 1992

Expiration Date

December 31, 2021

Current Date / Time

June 7, 2025
2:49:58 AM

License Relationships

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: BAKERSFIELD DENTAL GROUP

License/Registration Type: Fictitious Name Permit

License Number: 1473 Primary Status: Cancelled

Address :
1518 NILES STREET
BAKERSFIELD CA 93306
KERN COUNTY

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