Dental Board of California
Licensing details for: 11071
Name: DR. CLARK L. FONG, DDS, A PROFESSIONAL DENTAL CORP
License Type: Additional Office Permit
Primary Status: Cancelled
Organization Classification: Corporation
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: FONG, CLARK LEONG
License/Registration Type: Dentist License
License Number: 40351 Primary Status: Current - Active
Address :
401A N San Mateo Dr
SAN MATEO CA 94401-2417
SAN MATEO COUNTY
