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Licensing details for: 13669

Name: DENTISTRY 4 KIDS OF MORENO VALLEY, PRACTICE OF MOHAMAD ABDUL-FIELAT DDS, INC

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

12900 PERRIS BLVD #201
LAKE ELSINORE CA 92530
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Practice Location

12900 PERRIS BLVD #201
LAKE ELSINORE CA 92530
RIVERSIDE county
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Issuance Date

August 7, 2017

Expiration Date

June 30, 2019

Current Date / Time

June 7, 2025
8:38:53 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ABUL-FIELAT, MOHAMMAD GAZI

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: ABUL-FIELAT, MOHAMMAD GAZI

License/Registration Type: Dentist License

License Number: 43302 Primary Status: Current - Active

Address :
14275 Pipeline Ave
CHINO CA 91710-5639
SAN BERNARDINO COUNTY

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