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Licensing details for: 82151

Name: WALTER JEFFERSON, DDS

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

12050 VENTURA BLVD. STE. C-101
STUDIO CITY CA 91604
LOS ANGELES county
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Practice Location

12050 VENTURA BLVD. STE. C-101
STUDIO CITY CA 91604
LOS ANGELES county
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Issuance Date

April 11, 2025

Expiration Date

July 31, 2026

Current Date / Time

June 6, 2025
8:43:7 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: 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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