Dental Board of California
Licensing details for: 10518
Name: GOLDEN AGE DENTAL CARE, DENTAL PRACTICE OF BERKE DENTAL CORPORATI
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Secondary Status: Cancelled at the Request of the Licensee
Previous Names: GOLDEN AGE DENTAL CARE
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BERKE, SAMUEL DAVID
Address Not Disclosed
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: BERKE, SAMUEL DAVID
License/Registration Type: Dentist License
License Number: 26255 Primary Status: Expired
Address :
2705 BUNGALOW PLACE
CORONA DEL MAR CA 92625
ORANGE COUNTY
