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Licensing details for: 80215

Name: GERALD LOPEZ DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

12218 APPLE VALLEY ROAD, BLDG. 1, SUITE 110
APPLE VALLEY CA 92308
SAN BERNARDINO county
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Practice Location

12218 APPLE VALLEY ROAD, BLDG. 1, SUITE 110
APPLE VALLEY CA 92308
SAN BERNARDINO county
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Issuance Date

August 1, 2019

Expiration Date

August 31, 2026

Current Date / Time

June 6, 2025
3:37:2 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: GHAZAL, CAROLYN G

License/Registration Type: Dentist License

License Number: 38682 Primary Status: Current - Active

Address :
10797 FOOTHILL BLVD
RANCHO CUCAMONGA CA 91730
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: 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: 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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