Dental Board of California
Licensing details for: 5
Name: BLEDSOE, MARVIN RUSSELL
License Type: Oral Conscious Sedation
Primary Status: Cancelled
Specialty: Minor
Address of Record
1507 WEST YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: VALLEY OAK DENTAL GROUP M HOCHHALTER DDS
License/Registration Type: Fictitious Name Permit
License Number: 1121 Primary Status: Cancelled
Address :
B MOREHEAD DDS M BLEDSOE DDS
1507 W YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN 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: BLEDSOE, MARVIN RUSSELL
License/Registration Type: Dentist License
License Number: 30745 Primary Status: Cancelled
Address :
1507 WEST YOSEMITE AVENUE
MANTECA CA 95337
SAN JOAQUIN COUNTY
