Dental Board of California
Licensing details for: 1072
Name: TOWNGATE FAMILY DENTAL OFFICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Previous Names: TOWNGATE FAMILY DENTAL OFFICE, DR. UDAYN SHAH
Address of Record
DR UDAYN SHAH
12625 FREDERICK STREET STE F12
MORENO VALLEY CA 92553
RIVERSIDE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SHAH, UDAYN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SHAH, UDAY N
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: SHAH, UDAY N
License/Registration Type: Dentist License
License Number: 36426 Primary Status: Current - Active
Address :
14708 Pipeline Ave
Ste # A
CHINO HILLS CA 91709
SAN BERNARDINO COUNTY
