Dental Board of California
Licensing details for: 16125
Name: HERITAGE OAK DENTAL PRACTICE OF DOUGLAS & KLOSS DENTAL PARTNERSHIP
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Partnership
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: DOUGLAS, SHANE MARK
License/Registration Type: Dentist License
License Number: 61439 Primary Status: Current - Active
Address :
3700 ATHERTON RD
ROCKLIN CA 95765
PLACER 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: KLOSS, BENJAMIN DEVERE
License/Registration Type: Dentist License
License Number: 64527 Primary Status: Current - Active
Address :
3700 Atherton Rd
ROCKLIN CA 95765-3717
