Dental Board of California
Licensing details for: 3500
Name: THE SAN DIEGO CENTER FOR ORAL & MAXILLOFACIAL SURGERY
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
752 MEDICAL CENTER CT, STE 205
CHULA VISTA CA 91911
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KOHN, MARKELL W
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BERGER, JOEL S
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MACHADO, LESTER
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: KOHN, MARKELL W
License/Registration Type: Dentist License
License Number: 17302 Primary Status: Cancelled
Address :
14299 MANGO DRIVE
DEL MAR CA 92014
SAN DIEGO 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: BERGER, JOEL S
License/Registration Type: Dentist License
License Number: 35195 Primary Status: Current - Active
Address :
8008 Frost St Ste 311
SAN DIEGO CA 92123-4288
SAN DIEGO 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: MACHADO, LESTER
License/Registration Type: Dentist License
License Number: 29080 Primary Status: Expired
Address :
501 WASHINGTON AVE
STE 710
SAN DIEGO CA 92103
SAN DIEGO COUNTY
