Dental Board of California
Licensing details for: 17110
Name: MURRIETA MODERN DENTISTRY DENTALGROUP, JASON ANTONIO DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ANTONIO, JASON CLAY
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: ANTONIO, JASON CLAY
License/Registration Type: Dentist License
License Number: 59169 Primary Status: Current - Active
Address :
28080 Clinton Keith Rd
STE 100
MURRIETA CA 92563-4552
RIVERSIDE COUNTY
