Dental Board of California
Licensing details for: 14143
Name: FOLSOM DENTAL GROUP PRACTICE OF ULLOA AND LUQUE DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ULLOA, BRAULIO YEZID
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LUQUE, JUAN FERNANDO
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: ULLOA, BRAULIO YEZID
License/Registration Type: Dentist License
License Number: 47673 Primary Status: Current - Active
Address :
3448 Mission St
SAN FRANCISCO CA 94110-5437
SAN FRANCISCO COUNTY
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: LUQUE, JUAN FERNANDO
License/Registration Type: Dentist License
License Number: 48321 Primary Status: Current - Active
Address :
3085 24th St
STE 201
SAN FRANCISCO CA 94110
SAN FRANCISCO COUNTY
