Dental Board of California
Licensing details for: 3510
Name: TEETH "R" US CHILDREN DENTISTRY, DENTAL OFFICE OF DR. ANDRIANI ONGKORAHARDJO, D.D.S.
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
800 N DIAMOND BAR BLVD
DIAMOND BAR CA 91765
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ONGKORAHARDJO, ANDRIANI
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: ONGKORAHARDJO, ANDRIANI
License/Registration Type: Dentist License
License Number: 46120 Primary Status: Current - Active
Address :
660 N Diamond Bar Blvd
Suite 288
DIAMOND BAR CA 91765-1008
LOS ANGELES COUNTY
