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Licensing details for: 80386

Name: ESPINO & MEDINA DDS INC.

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

1227 W FOOTHILL BLVD.
UPLAND CA 91786
SAN BERNARDINO county
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Practice Location

1227 W FOOTHILL BLVD.
UPLAND CA 91786
SAN BERNARDINO county
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Issuance Date

November 26, 2019

Expiration Date

January 31, 2023

Current Date / Time

June 6, 2025
2:21:23 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: Espino, Elizabeth Alicia

License/Registration Type: Dentist License

License Number: 63173 Primary Status: Current - Active

Address :
2211 University Ave
RIVERSIDE CA 92507-4259

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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: MEDINA, DAVID O

License/Registration Type: Dentist License

License Number: 57425 Primary Status: Current - Active

Address :
2211 University Ave
RIVERSIDE CA 92507-4259
RIVERSIDE COUNTY

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