Dental Board of California
Licensing details for: 13379
Name: DENTISTRY AT EMPIRE LAKES, DENTAL PRACTICE OF SANDY I. DIZON JR, DDS
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Sole Owner
Previous Names: Sandy I. Dizon Jr., DDS, Inc
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DIZON JR, SANDY INTON
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: DIZON JR, SANDY INTON
License/Registration Type: Dentist License
License Number: 53059 Primary Status: Current - Active
Address :
9640 Milliken Ave
104
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO COUNTY
