Dental Board of California
Licensing details for: 17993
Name: NU DENTAL PRACTICE OF KIATKACHORN RATANATHARATHORN, DDS INC
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: Kiatkachorn Ratanatharathorn, DDS Inc
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RATANATHARATHORN, KIATKACHORN
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: RATANATHARATHORN, KIATKACHORN
License/Registration Type: Dentist License
License Number: 102782 Primary Status: Current - Active
Address :
2420 S Azusa Ave
WEST COVINA CA 91792-1512
SAN BERNARDINO COUNTY
