Dental Board of California
Licensing details for: 5358
Name: MAVERN SUPRONO DDS INC
License Type: Additional Office Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
1080 EAST WASHINGTON
SUITE B
COLTON CA 91324
SAN BERNARDINO county
Map
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: SUPRONO, MAVERN SERMIN
License/Registration Type: Dentist License
License Number: 27842 Primary Status: Expired
Address :
P.O. BOX 13218
SAN BERNARDINO CA 92423
SAN BERNARDINO COUNTY
