Dental Board of California
Licensing details for: 3975
Name: GRAPEVINE DENTAL OFFICE, MICHAEL DE LA CRUZ,
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
12085 HEACOCK ST
MORENO VALLEY CA 92557
RIVERSIDE county
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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: DE LA CRUZ, MICHAEL M F LUNA JR
License/Registration Type: Dentist License
License Number: 38829 Primary Status: Current - Active
Address :
12085 HEACOCK ST
MORENO VALLEY CA 92557
RIVERSIDE COUNTY
