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Licensing details for: 80235

Name: PENAFLORIDA DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

2878 CAMPUS PKWY., SUITE 1
RIVERSIDE CA 92507
RIVERSIDE county
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Practice Location

2878 CAMPUS PKWY., SUITE 1
RIVERSIDE CA 92507
RIVERSIDE county
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Issuance Date

August 19, 2019

Expiration Date

September 30, 2026

Current Date / Time

June 6, 2025
3:20:2 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: JACKSON, TANISHA ANJANETTE

License/Registration Type: Dentist License

License Number: 47103 Primary Status: Current - Active

Address :
422 Orange St
REDLANDS CA 92374-3206
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: PENAFLORIDA, NEIL GRANT

License/Registration Type: Dentist License

License Number: 58441 Primary Status: Current - Active

Address :
2878 Campus Pkwy
Ste 1
RIVERSIDE CA 92507-0966
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: 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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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: CHANG, ANDREW ANCHU

License/Registration Type: Dentist License

License Number: 60298 Primary Status: Current - Active

Address :
2878 Campus Pkwy
STE 1
RIVERSIDE CA 92507-0966
RIVERSIDE COUNTY

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