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Licensing details for: 13920

Name: CHILDREN'S DENTAL FUNZONE, DENTAL GROUP OF MARIA CAMILA BORRERO FONSECA, DDS

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

569 W LOWELL BLVD STE 200
TRACY CA 95376
SAN JOAQUIN county
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Practice Location

569 W LOWELL BLVD STE 200
TRACY CA 95376
SAN JOAQUIN county
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Issuance Date

December 13, 2017

Expiration Date

September 30, 2026

Current Date / Time

December 13, 2025
2:6:29 PM

License Relationships

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: Borrero Fonseca, Maria Camila

License/Registration Type: Dentist License

License Number: 51046 Primary Status: Current - Active

Address :
569 W LOWELL AVE
STE 200
TRACY CA 95376
SAN JOAQUIN COUNTY

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