Dental Board of California
Licensing details for: 3839
Name: INDIO FAMILY DENTAL PRACTICE, A DENTAL OFFICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
81557 DR CARREON BLVD, #D-3
INDIO CA 92201
RIVERSIDE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: IBRAHIM, MAISY SAMI
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: IBRAHIM, MAISY SAMI
License/Registration Type: Dentist License
License Number: 43447 Primary Status: Current - Active
Address :
41990 COOK STREET
STE D402
PALM DESERT CA 92211
RIVERSIDE COUNTY
