Dental Board of California
Licensing details for: 227
Name: ONGKORAHARDJO, ANDRIANI
License Type: Oral Conscious Sedation
Primary Status: Cancelled
Specialty: Minor
Address of Record
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES county
Map
License Relationships
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 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
OCS to DDS, OMS, or SP
License/Registration Role: Oral Conscious Sedation Certificate
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: ONGKORAHARDJO, ANDRIANI
License/Registration Type: Dentist License
License Number: 46120 Primary Status: Current - Active
Address :
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES COUNTY
