Dental Board of California
Licensing details for: 15076
Name: RUSSIKOFF FAMILY DENTISTRY DENTAL OFFICE OF GARRETT RUSSIKOFF
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: WOODSTONE PLAZA DENTAL, A PRACTICE OF GARRETT RUSSIKOFF, D.M.D., INC.
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RUSSIKOFF, GARRETT MATTHEW
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: RUSSIKOFF, GARRETT MATTHEW
License/Registration Type: Dentist License
License Number: 102465 Primary Status: Current - Active
Address :
18911 Nordhoff St. Unit 35
18911 Nordhoff St. Unit 35
NORTHRIDGE CA 91324
