Dental Board of California
Licensing details for: 12593
Name: CENTRAL CALIFORNIA CHILDREN'S DENTISTRY AND ORTHODONTICS DENTAL O
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
6245 N. FRESNO STREET, SUITE 103
FRESNO CA 93710
FRESNO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PRIETO, JORDAN DAVID
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: PRIETO, JORDAN DAVID
License/Registration Type: Dentist License
License Number: 61309 Primary Status: Current - Active
Address :
1900 Shaw Ave
101
CLOVIS CA 93611-4208
FRESNO COUNTY
