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Licensing details for: 79265

Name: JEFFERSON AND SCHMIDT DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

16745 SIERRA LAKES PKWY STE 140
FONTANA CA 92336
SAN BERNARDINO county
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Practice Location

16745 SIERRA LAKES PKWY STE 140
FONTANA CA 92336
SAN BERNARDINO county
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Issuance Date

March 28, 2017

Expiration Date

November 30, 2026

Current Date / Time

June 6, 2025
3:38:36 PM

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: MOORE, ANDREA CHRISTIANE

License/Registration Type: Dentist License

License Number: 48337 Primary Status: Current - Active

Address :
1875 N Campus Ave
UPLAND CA 91784-8208
SAN BERNARDINO COUNTY

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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: SCHMIDT, CHRISTIAN DAVID

License/Registration Type: Dentist License

License Number: 61757 Primary Status: Current - Active

Address :
11508 Grimaldi Rd
RANCHO CUCAMONGA CA 91701-9220
SAN BERNARDINO COUNTY

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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: SAMBANGI, MANORANJANI

License/Registration Type: Dentist License

License Number: 50520 Primary Status: Current - Active

Address :
CHINO HILLS DENTAL GROUP
3410 GRAND AVE
CHINO HILLS CA 91709
SAN BERNARDINO COUNTY

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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: CHOKKA, SUDHAKAR RAO

License/Registration Type: Dentist License

License Number: 41376 Primary Status: Current - Active

Address :
27949 Greenspot Rd
Ste. H
HIGHLAND CA 92346-4443
SAN BERNARDINO COUNTY

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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: JEFFERSON, WALTER

License/Registration Type: Dentist License

License Number: 53460 Primary Status: Current - Active

Address :
16475 SIERRA LAKES PKWY
STE 140
FONTANA CA 92336
SAN BERNARDINO COUNTY

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