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Licensing details for: 4084

Name: KANSAGRA, KRISHNA P

License Type: Oral Conscious Sedation

Primary Status: Cancelled

Specialty: Minor

Previous Names: KANSAGRA, KRISHNA PRAVINKUMAR

Address of Record

16157 MURPHY AVE
IRVINE CA 92606
ORANGE county
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Practice Location

16946 Marygold Ave
FONTANA CA 92335-1724
SAN BERNARDINO county
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Issuance Date

December 23, 2020

Expiration Date

June 30, 2024

Current Date / Time

June 22, 2025
3:15:54 AM

License Relationships

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: KANSAGRA, KRISHNA P

License/Registration Type: Dentist License

License Number: 64979 Primary Status: Current - Active

Address :
168 N Euclid Ave
UPLAND CA 91786-6035
SAN BERNARDINO COUNTY

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