Dental Board of California
Licensing details for: 12774
Name: GIA DENTAL GROUP, DENTAL GROUP OF IVAN R. MORENO, DDS, INC.
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
License Relationships
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: MORENO, IVAN ROEL
License/Registration Type: Dentist License
License Number: 49605 Primary Status: Current - Active
Address :
355 K ST. STE A
CHULA VISTA CA 91911
SAN DIEGO COUNTY
