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Licensing details for: 10925

Name: SPECIALTY CENTER OF SAN FERNANDO, AN A.R. BAKER, D.D.S. DENTAL GR

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

1240 TRUMAN STREET #200
SAN FERNANDO CA 91340
LOS ANGELES county
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Practice Location

500 San Fernando Mission Blvd
Suite 200
SAN FERNANDO CA 91340-4061
LOS ANGELES county
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Issuance Date

November 21, 2013

Expiration Date

December 31, 2018

Current Date / Time

June 6, 2025
9:56:27 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: BAKER, ALLEN RONALD

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: BAKER, ALLEN RONALD

License/Registration Type: Dentist License

License Number: 20609 Primary Status: Current - Active

Address :
500 San Fernando Mission Blvd
Ste 200
SAN FERNANDO CA 91340-4061
LOS ANGELES COUNTY

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