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Licensing details for: 82198

Name: WALTER JEFFERSON, DDS

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

2710 CARSON ST.
LAKEWOOD CA 90712
LOS ANGELES county
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Practice Location

2710 CARSON ST.
LAKEWOOD CA 90711
LOS ANGELES county
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Issuance Date

April 30, 2025

Expiration Date

July 31, 2026

Current Date / Time

June 6, 2025
8:56:26 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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