Dental Board of California
Licensing details for: 1473
Name: BAKERSFIELD DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
1518 NILES STREET
BAKERSFIELD CA 93306
KERN county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SUWANTAVEESRI, TATSANEE
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: THIO, YURITA
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: STEWART, WILBURN CARSON
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MATIAN, FARIBORZ
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: STEWART, WILBURN CARSON
License/Registration Type: Dentist License
License Number: 31395 Primary Status: Voluntary Surrendered
Address :
203 WALNUT STREET
POCOMORE MD 21851
WORCESTER 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: MATIAN, FARIBORZ
License/Registration Type: Dentist License
License Number: 40272 Primary Status: Current - Active
Address :
19900 VENTURA BLVD
SUITE 200
WOODLAND HILLS CA 91364
LOS ANGELES 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: SUWANTAVEESRI, TATSANEE
License/Registration Type: Dentist License
License Number: 40120 Primary Status: Cancelled
Address :
712 VOORHEES AVE
MIDDLESEX NJ 08846
MIDDLESEX 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: THIO, YURITA HARTOJO
License/Registration Type: Dentist License
License Number: 40030 Primary Status: Expired
Address :
4428 Arcola Ave
TOLUCA LAKE CA 91602
LOS ANGELES COUNTY
