Dental Board of California
Licensing details for: 13050
Name: SMILES OF LA MESA, DENTAL PRACTICE OF PRASAD GONAVARUM, D.D.S., PROFESSIONAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
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: GONAVARUM, PRASAD B
License/Registration Type: Dentist License
License Number: 64360 Primary Status: Current - Active
Address :
7122 UNIVERSITY AVE
LA MESA CA 91942-5926
SAN DIEGO COUNTY
