Dental Board of California
Licensing details for: 17291
Name: BEDFORD MODERN DENTISTRY DENTAL GROUP, ROQUIZ AND DHAMA 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: DO YABUT, DIANA SONG
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LEE, FREDERICK HYUN WOO
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DHAMA, DEEPIKA S
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ROQUIZ, DAVID RAY
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: DHAMA, DEEPIKA S
License/Registration Type: Dentist License
License Number: 49044 Primary Status: Current - Active
Address :
2044 California Ave
CORONA CA 92881-3300
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: DO YABUT, DIANA SONG
License/Registration Type: Dentist License
License Number: 53903 Primary Status: Current - Active
Address :
20201 CHIANTI COURT
YORBA LINDA CA 92886
ORANGE 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: LEE, FREDERICK HYUN WOO
License/Registration Type: Dentist License
License Number: 43359 Primary Status: Current - Active
Address :
4000 W. FLORIDA AVE.
HEMET CA 92545
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: ROQUIZ, DAVID RAY
License/Registration Type: Dentist License
License Number: 63993 Primary Status: Current - Active
Address :
11132 MORNINGSTAR PL
LOMA LINDA CA 92354
SAN BERNARDINO COUNTY
