Dental Board of California
Licensing details for: 11802
Name: CHULA VISTA ORAL & MAXILLOFACIAL SURGERY CENTER, DENTAL OFFICE OF
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHULA VISTA ORAL & MAXILLOFACIAL SURGERY CENTER, DENTAL OFFICE OF
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: TILLNER, JOHN E JR
License/Registration Type: Dentist License
License Number: 52944 Primary Status: Current - Active
Address :
769 MEDICAL CENTER CT #200
CHULA VISTA CA 91911
SAN DIEGO COUNTY
