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Licensing details for: 10293

Name: COMPEAN AND JEFFERSON DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

14305 BASELINE AVENUE
FONTANA CA 92336
SAN BERNARDINO county
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Practice Location

14305 BASELINE AVENUE
FONTANA CA 92336
SAN BERNARDINO county
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Issuance Date

September 28, 2010

Expiration Date

May 31, 2015

Current Date / Time

June 7, 2025
8:52:15 AM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: COMPEAN, CARLOS GUILLERMO

License/Registration Type: Dentist License

License Number: 29127 Primary Status: Current - Active

Address :
10945South St. Ste. 200A
CERRITOS CA 90703
LOS ANGELES COUNTY

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