Dental Board of California
Licensing details for: 13144
Name: APPLE VALLEY DENTAL OFFICE
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KIM, SAMUEL I
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: KIM, SAMUEL I
License/Registration Type: Dentist License
License Number: 51348 Primary Status: Current - Active
Address :
17768 Wika Rd # 100
APPLE VALLEY CA 92307-1200
SAN BERNARDINO COUNTY
