Dental Board of California
Licensing details for: 13088
Name: SURFSIDE KIDS DENTAL GROUP, RAWLINS & LYONS
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LYONS, TIMOTHY JAMES
Address Not Disclosed
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
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: RAWLINS, JOSEPH T
License/Registration Type: Dentist License
License Number: 56958 Primary Status: Current - Active
Address :
4420 TOWN CENTER BLVD.
SUITE #220
EL DORADO HILLS CA 95762
EL DORADO COUNTY
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: LYONS, TIMOTHY JAMES
License/Registration Type: Dentist License
License Number: 51968 Primary Status: Current - Active
Address :
4420 Town Center Blvd
Suite 200
EL DORADO HILLS CA 95762
EL DORADO COUNTY
