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Licensing details for: 80211

Name: ALFONSO AND LOPEZ DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

20258 US HWY. 18 SUITE 400
APPLE VALLEY CA 92307
SAN BERNARDINO county
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Practice Location

20258 US HWY. 18 SUITE 400
APPLE VALLEY CA 92307
SAN BERNARDINO county
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Issuance Date

August 1, 2019

Expiration Date

August 31, 2022

Current Date / Time

June 6, 2025
2:12:30 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: 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: ALFONSO, ANTONIO ANDREW

License/Registration Type: Dentist License

License Number: 63500 Primary Status: Current - Active

Address :
732 MOTT ST, STE 100-110
SAN FERNANDO CA 91340
LOS ANGELES 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: 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: 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: LOPEZ, GERALD

License/Registration Type: Dentist License

License Number: 57332 Primary Status: Current - Active

Address :
12218 Apple Valley Rd
Bldg 1, Ste 110
APPLE VALLEY CA 92308-1703
SAN BERNARDINO COUNTY

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