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Licensing details for: 2700

Name: RIVERSIDE DENTAL PRACTICE

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

3630 CENTRAL AVENUE SUITE I
RIVERSIDE CA 92506
RIVERSIDE county
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Issuance Date

April 3, 2000

Expiration Date

September 30, 2004

Current Date / Time

June 6, 2025
9:22:42 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: WATANABE, LYNDA CAROL

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: WATANABE, LYNDA CAROL

License/Registration Type: Dentist License

License Number: 40116 Primary Status: Current - Active

Address :
8715 Trautwein Rd
RIVERSIDE CA 92508-9474
RIVERSIDE COUNTY

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