Dental Board of California
Licensing details for: 2717
Name: MORENO VALLEY ENDODONTICS DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Partnership
Address of Record
12810 HEACOCK STREET SUITE B-105
MORENO VALLEY CA 92553
RIVERSIDE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DIAZ, LYNN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MARCKS, KURT OTTO
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: MARCKS, KURT OTTO
License/Registration Type: Dentist License
License Number: 42360 Primary Status: Current - Active
Address :
5185 Palisade Cir
RIVERSIDE CA 92506-1553
RIVERSIDE 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: DIAZ, LYNN
License/Registration Type: Dentist License
License Number: 42728 Primary Status: Current - Active
Address :
24099 Postal Ave Ste 101
MORENO VALLEY CA 92553-7709
RIVERSIDE COUNTY
