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Licensing details for: 4112

Name: ASSAD, MARTINA M

License Type: Oral Conscious Sedation

Primary Status: Expired Primary Status Definition

Specialty: Adult

Address of Record

7483 Blue Oak Rd
RIVERSIDE CA 92507
RIVERSIDE county
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Practice Location

22430 Van Buren Blvd
200
RIVERSIDE CA 92518-2709
RIVERSIDE county
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Issuance Date

January 29, 2021

Expiration Date

October 31, 2023

Current Date / Time

June 6, 2025
3:2:7 PM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: MA DENTAL PRACTICE OF MARTINA ASSAD, DDS, INC.

License/Registration Type: Fictitious Name Permit

License Number: 17431 Primary Status: Current - Active

Address :
22430 VAN BUREN BLVD SUITE 200
MARCH AIR RESERVE BA CA 92518
RIVERSIDE COUNTY

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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: ASSAD, MARTINA M

License/Registration Type: Dentist License

License Number: 100600 Primary Status: Current - Active

Address :
22430 Van Buren Blvd
200
RIVERSIDE CA 92518-2709
RIVERSIDE COUNTY

Map

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