Dental Board of California
Licensing details for: 3572
Name: FAIRWAY PARK DENTAL OFFICE,
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Sole Owner
Address of Record
31111 MISSION BLVD
HAYWARD CA 94544
ALAMEDA county
Map
License Relationships
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: FONTABLA, ROSALYN CASARENO
License/Registration Type: Dentist License
License Number: 45691 Primary Status: Current - Active
Address :
31111 MISSION BLVD
HAYWARD CA 94544
ALAMEDA COUNTY
