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Licensing details for: 15378

Name: SPLASH KIDS DENTAL CARE DENTAL OFFICE OF KAUR & BORRERO DDS DENTAL CORP.

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

1801 TULLY RD STE A1
MODESTO CA 95350
STANISLAUS county
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Practice Location

1801 TULLY RD STE A1
MODESTO CA 95350
STANISLAUS county
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Issuance Date

October 2, 2019

Expiration Date

September 30, 2020

Current Date / Time

June 6, 2025
10:13:52 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: BORRERO FONSECA, MARIA CAMILA

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: 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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