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Licensing details for: 3727

Name: CHILDREN'S DENTAL FUN ZONE, DENTAL PRACTICE

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

2233 EAST GARVEY AVE NORTH
WEST COVINA CA 91791
LOS ANGELES county
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Issuance Date

June 19, 2002

Expiration Date

December 31, 2020

Current Date / Time

June 7, 2025
4:2:37 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: TO, MICHELLE

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: RODEF, FARIBORZ

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: RODEF, FARIBORZ

License/Registration Type: Dentist License

License Number: 38356 Primary Status: Current - Active

Address :
2233 E GARVEY AVE N
WEST COVINA CA 91791
LOS ANGELES COUNTY

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