Dental Board of California
Licensing details for: 11609
Name: LAKESHORE ORAL & MAXILLOFACIAL SURGERY SPECIALTY, DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KRAKOWIAK, PETER ADAM
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: KRAKOWIAK, PETER ADAM
License/Registration Type: Dentist License
License Number: 49350 Primary Status: Current - Active
Address :
25460 Medical Center Dr
201
MURRIETA CA 92562-5966
RIVERSIDE COUNTY
