Dental Board of California
Licensing details for: 1391
Name: DENTAL ASSOCIATES OF COLTON
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
Previous Names: DENTAL ASSOCIATES OF COLTON, OFFICE OF DR. M. SUPRONO
Address of Record
OFFICE OF DR M SUPRONO
1080 EAST WSHINGTON STREET, SUITE B
COLTON CA 92324
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SUPRONO, MAVERN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SUPRONO, MAVERN SERMIN
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: SUPRONO, MAVERN SERMIN
License/Registration Type: Dentist License
License Number: 27842 Primary Status: Expired
Address :
P.O. BOX 13218
SAN BERNARDINO CA 92423
SAN BERNARDINO COUNTY
