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Licensing details for: 81301

Name: BORRERO DENTAL CORP.

License Type: Additional Office Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

140 E. GRANT LINE RD
TRACY CA 95376
SAN JOAQUIN county
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Practice Location

140 E. GRANT LINE RD
TRACY CA 95376
SAN JOAQUIN county
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Issuance Date

October 5, 2022

Expiration Date

September 30, 2022

Current Date / Time

December 13, 2025
9:49:26 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: Borrero Fonseca, Maria Camila

License/Registration Type: Dentist License

License Number: 51046 Primary Status: Current - Active

Address :
569 W LOWELL AVE
STE 200
TRACY CA 95376
SAN JOAQUIN COUNTY

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