Dental Board of California
Licensing details for: 1392
Name: DENTAL ASSOCIATES OF POMONA
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: DENTAL ASSOCIATES OF POMONA, OFFICE OF DR. M. SUPRONO ❖ DENTAL ASSOCIATES OF POMONA OFFICE OF DR M SUPRONO
Address of Record
OFFICE OF DR M SUPRONO
180 EAST MISSION BLVD
POMONA CA 91766
LOS ANGELES county
Map
License Relationships
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
