Dental Board of California
Licensing details for: 57058
Name: KATBAMNA, DIPAK
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Secondary Status: Public Reprimand
Previous Names: KATBAMNA, DIPAK A
Address of Record
11916 Berlyn Dove Ct
JURUPA VALLEY CA 91752-2927
RIVERSIDE county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MA FAMILY DENTISTRY DENTAL PRACTICE OF DIPAK KATBAMNA DDS P.C.
License/Registration Type: Fictitious Name Permit
License Number: 12896 Primary Status: Expired
Address :
4365 PHELAN ROAD
PHELAN CA 92371
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: MA FAMILY DENTISTRY DENTAL PRACTICE OF DIPAK KATBAMNA DDS P.C.
License/Registration Type: Fictitious Name Permit
License Number: 12896 Primary Status: Expired
Address :
4365 PHELAN ROAD
PHELAN CA 92371
SAN BERNARDINO COUNTY
