Dental Board of California
Licensing details for: 1104
Name: THE BRACE CONNECTION DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
1468 INDUSTRIAL PARK DRIVE
REDLANDS CA 92373
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SHIBATA, WILLIAM HOWARD
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KETCHERSIDE, H GARY
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KETCHERSIDE, HOMER GARY
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: STOCKDALE, ROBERT CHARLES
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: KETCHERSIDE, HOMER GARY
License/Registration Type: Dentist License
License Number: 28872 Primary Status: Current - Active
Address :
400 W Stuart AVe
ste.110
REDLANDS CA 92374
SAN BERNARDINO COUNTY
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: STOCKDALE, ROBERT CHARLES
License/Registration Type: Dentist License
License Number: 30716 Primary Status: Current - Active
Address :
10399 Foothill Blvd
Suite 102
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO COUNTY
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: SHIBATA, WILLIAM HOWARD
License/Registration Type: Dentist License
License Number: 32613 Primary Status: Expired
Address :
34-400 DATE PALM DRIVE
SUITE E
CATHEDRAL CITY CA 92234
RIVERSIDE COUNTY
