Dental Board of California
Licensing details for: 17500
Name: PALM BLUFFS DENTAL GROUP INC. PRACTICE OF DR. PRIETO
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
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: PRIETO, JORDAN DAVID
License/Registration Type: Dentist License
License Number: 61309 Primary Status: Current - Active
Address :
1900 Shaw Ave
101
CLOVIS CA 93611-4208
FRESNO 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: KUNKEL, JEFF RALPH
License/Registration Type: Dentist License
License Number: 60083 Primary Status: Current - Active
Address :
7525 N Cedar Ave Ste 105
FRESNO CA 93720-2698
FRESNO 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: O'HARA, STEPHEN DONALD
License/Registration Type: Dentist License
License Number: 46666 Primary Status: Current - Active
Address :
7770 N Fresno St Ste 101
FRESNO CA 93720-2412
FRESNO 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: EVANS, JEFFREY BAIRD
License/Registration Type: Dentist License
License Number: 59512 Primary Status: Current - Active
Address :
7525 N. CEDAR AVE
SUITE 105
FRESNO CA 93720
FRESNO COUNTY
