Dental Board of California
Licensing details for: 2686
Name: CARNELIAN FAMILY DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
6626 CARNELIAN STREET
ALTA LOMA CA 91701
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TAO, GEORGE JI-JUN
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: TAO, GEORGE JI-JUN
License/Registration Type: Dentist License
License Number: 42703 Primary Status: Current - Active
Address :
9588 Base Line Rd
Suite 100
ALTA LOMA CA 91701-6439
SAN BERNARDINO COUNTY
