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Licensing details for: 17248

Name: CHINO HILLS DENTAL GROUP, GILL AND SAMBANGI DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

3410 GRAND AVENUE., SUITE F
CHINO HILLS CA 91709
SAN BERNARDINO county
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Practice Location

17000 RED HILL AVENUE
IRVINE CA 92614
ORANGE county
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Issuance Date

July 13, 2022

Expiration Date

July 31, 2023

Current Date / Time

December 13, 2025
9:42:34 AM

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: MOORE, ANDREA CHRISTIANE

License/Registration Type: Dentist License

License Number: 48337 Primary Status: Expired

Address :
1875 N Campus Ave
UPLAND CA 91784-8208
SAN BERNARDINO COUNTY

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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

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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: SAMBANGI, MANORANJANI

License/Registration Type: Dentist License

License Number: 50520 Primary Status: Current - Active

Address :
CHINO HILLS DENTAL GROUP
3410 GRAND AVE
CHINO HILLS CA 91709
SAN BERNARDINO COUNTY

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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

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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: GILL, RITTU

License/Registration Type: Dentist License

License Number: 48274 Primary Status: Current - Active

Address :
2468 San Antonio Cres E
UPLAND CA 91784-1180
SAN BERNARDINO COUNTY

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