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Licensing details for: 10537

Name: CULVER DEL REY DENTAL CENTER, PAUL B. PALMER, DDS, INC., DENTAL O

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

12202 W. WASHINGTON BOULEVARD
LOS ANGELES CA 90066
LOS ANGELES county
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Practice Location

12202 W. WASHINGTON BOULEVARD
LOS ANGELES CA 90066
LOS ANGELES county
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Issuance Date

June 11, 2013

Expiration Date

November 13, 2018

Current Date / Time

December 13, 2025
9:44:1 AM

License Relationships

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: PALMER, PAUL BRIAN

License/Registration Type: Dentist License

License Number: 28603 Primary Status: Current - Inactive

Address :
23569 Sunnymead Ranch Pkwy
ste A
MORENO VALLEY CA 92557-2884
RIVERSIDE COUNTY

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