Dental Board of California
Licensing details for: 46120
Name: ONGKORAHARDJO, ANDRIANI
License Type: Dentist
Primary Status: Current - Active
Address of Record
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES 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: DR. ANDRIANI ONGKORAHARDJO, DDS, INC.
License/Registration Type: Additional Office Permit
License Number: 9703 Primary Status: Cancelled
Address :
99 N. LA CIENEGA BLVD.
STE. 308
BEVERLY HILLS CA 90211
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: TEETH "R" US CHILDREN DENTISTRY, DENTAL OFFICE OF DR. ANDRIANI ONGKORAHARDJO, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 3510 Primary Status: Cancelled
Address :
800 N DIAMOND BAR BLVD
DIAMOND BAR CA 91765
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: TEETH "R" US CHILDREN DENTISTRY, DENTAL OFFICE OF DR. ANDRIANI ONGKORAHARDJO, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 14031 Primary Status: Current - Active
Address :
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES 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: TEETH "R" US CHILDREN DENTISTRY, DENTAL OFFICE OF DR. ANDRIANI ONGKORAHARDJO, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 3510 Primary Status: Cancelled
Address :
800 N DIAMOND BAR BLVD
DIAMOND BAR CA 91765
LOS ANGELES 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: TEETH "R" US CHILDREN DENTISTRY, DENTAL OFFICE OF DR. ANDRIANI ONGKORAHARDJO, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 14031 Primary Status: Current - Active
Address :
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES 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: ONGKORAHARDJO, ANDRIANI
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 227 Primary Status: Cancelled
Address :
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES COUNTY
PMS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Pediatric Minimal Sedation Permit
Name: ONGKORAHARDJO, ANDRIANI
License/Registration Type: Pediatric Minimal Sedation Permit
License Number: 181 Primary Status: Current - Active
Address :
660 N. DIAMOND BAR BLVD. SUITE 288
DIAMOND BAR CA 91765
LOS ANGELES COUNTY
