Dental Board of California
Licensing details for: 12452
Name: CHILDREN'S DENTAL FUN ZONE - BORRERO DENTAL OFFICE #2
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: CHILDREN'S DENTAL FUN ZONE
Address of Record
675 CONTRA COSTA BLVD
PLEASANT HILL CA 94523
CONTRA COSTA county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BORRERO FONSECA, MARIA CAMILA
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: Borrero Fonseca, Maria Camila
License/Registration Type: Dentist License
License Number: 51046 Primary Status: Current - Active
Address :
569 W LOWELL AVE
STE 200
TRACY CA 95376
SAN JOAQUIN COUNTY
