Dental Board of California
Licensing details for: 45194
Name: SHRIVER, NENI DIAH
License Type: Dentist
Primary Status: Current - Active
Address of Record
7817 Ivanhoe Ave. Ste.304
LA JOLLA CA 92037
SAN DIEGO county
Map
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: DR. SHRIVER'S LA JOLLA SMILE CENTER DENTAL PRACTICE
License/Registration Type: Fictitious Name Permit
License Number: 12085 Primary Status: Expired
Address :
7817 IVANHOE AVENUE, SUITE 304
LA JOLLA CA 92037
SAN DIEGO 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: SHRIVER, NENI DIAH
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 3407 Primary Status: Current - Active
Address :
7817 IVANHOE AVE SUITE 304
LA JOLLA CA 92037
SAN DIEGO 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: SHRIVER, NENI DIAH
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 3904 Primary Status: Cancelled
Address :
7817 Ivanhoe Ave Ste 304
LA JOLLA CA 92037-4555
SAN DIEGO COUNTY
