Dental Board of California
Licensing details for: 17412
Name: SURFSIDE KIDS DENTAL PRACTICE OF JOSEPH RAWLINS DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: SURFSIDE KIDS DENTAL PRACTICE
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RAWLINS, JOSEPH T
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: RAWLINS, JOSEPH T
License/Registration Type: Dentist License
License Number: 56958 Primary Status: Current - Active
Address :
4420 TOWN CENTER BLVD.
SUITE #220
EL DORADO HILLS CA 95762
EL DORADO COUNTY
