Dental Board of California
Licensing details for: 16744
Name: KIDS CARE DENTIST COLLECTIVE - DENTAL PRACTICE OF REEVES, D.D.S. AND LAVALLEY, D.D.S., A DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: FULFORD, REGINALD LAMAR
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: FULFORD, REGINALD LAMAR
License/Registration Type: Dentist License
License Number: 49520 Primary Status: Current - Active
Address :
208 Classic Ct
WEST SACRAMENTO CA 95605-2567
SACRAMENTO COUNTY
