Dental Board of California
Licensing details for: 17126
Name: SAN DIMAS DENTAL OFFICE, ZAKLAMA 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: HERNANDEZ, ALEXIS
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: JEFFERSON, WALTER
License/Registration Type: Dentist License
License Number: 53460 Primary Status: Current - Active
Address :
16475 SIERRA LAKES PKWY
STE 140
FONTANA CA 92336
SAN BERNARDINO 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: HERNANDEZ, ALEXIS
License/Registration Type: Dentist License
License Number: 100620 Primary Status: Current - Active
Address :
1697 Justine Way
UPLAND CA 91784-8068
SAN BERNARDINO 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: CHOKKA, SUDHAKAR RAO
License/Registration Type: Dentist License
License Number: 41376 Primary Status: Current - Active
Address :
27949 Greenspot Rd
Ste. H
HIGHLAND CA 92346-4443
SAN BERNARDINO 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: WATANABE, BRYAN KAZUMI
License/Registration Type: Dentist License
License Number: 40130 Primary Status: Current - Active
Address :
40760 California Oaks Rd.
MURRIETA CA 92562
RIVERSIDE 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: ZAKLAMA, KARIM MAGID
License/Registration Type: Dentist License
License Number: 61349 Primary Status: Current - Active
Address :
2700 E Workman Ave
WEST COVINA CA 91791-6625
LOS ANGELES COUNTY
