Dental Board of California
Licensing details for: 17498
Name: MOUNTAINSIDE DENTAL GROUP PRACTICE OF WOLFRAM 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: WOLFRAM, STEVEN MARK
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: WOLFRAM, STEVEN MARK
License/Registration Type: Dentist License
License Number: 52164 Primary Status: Current - Active
Address :
11834 BRYANT STREET
SUITE 104
YUCAIPA CA 92399
SAN BERNARDINO COUNTY
