Dental Board of California
Licensing details for: 16606
Name: DENTASTIC DENTAL GROUP OF JORGE ENCISO, DDS, INC.
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Sole Owner
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ENCISO, JORGE
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: ENCISO, JORGE
License/Registration Type: Dentist License
License Number: 104037 Primary Status: Current - Active
Address :
13554 DOUGLAS ST.
YUCAIPA CA 92399
SAN BERNARDINO COUNTY
