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Licensing details for: 80170

Name: DIMITRI DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

12571 LIMONITE AVENUE, SUITE 230
MIRA LOMA CA 91752
RIVERSIDE county
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Practice Location

12571 LIMONITE AVENUE, SUITE 230
MIRA LOMA CA 91752
RIVERSIDE county
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Issuance Date

July 16, 2019

Expiration Date

June 30, 2026

Current Date / Time

June 6, 2025
2:25:28 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: WATANABE, BRYAN KAZUMI

License/Registration Type: Dentist License

License Number: 40130 Primary Status: Current - Active

Address :
40760 California Oaks Rd.
MURRIETA CA 92562
RIVERSIDE 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: DO YABUT, DIANA SONG

License/Registration Type: Dentist License

License Number: 53903 Primary Status: Current - Active

Address :
20201 CHIANTI COURT
YORBA LINDA CA 92886
ORANGE 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: DIMITRI, RAMI GEORGE

License/Registration Type: Dentist License

License Number: 48596 Primary Status: Current - Active

Address :
8865 E Garden View Dr
ANAHEIM CA 92808-1678
ORANGE 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: DHAMA, DEEPIKA S

License/Registration Type: Dentist License

License Number: 49044 Primary Status: Current - Active

Address :
2044 California Ave
CORONA CA 92881-3300
RIVERSIDE COUNTY

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