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Licensing details for: 4147

Name: MILLBRAE DENTAL CENTER, DENTAL PRACTICE OF

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Partnership

Address of Record

15 EL CAMINO REAL
MILLBRAE CA 94030
SAN MATEO county
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Issuance Date

March 10, 2003

Expiration Date

February 29, 2004

Current Date / Time

June 5, 2026
5:48:25 PM

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: YOON, ANNA

License/Registration Type: Dentist License

License Number: 45218 Primary Status: Cancelled

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: DE LEON, MARIA VALERIE POZON

License/Registration Type: Dentist License

License Number: 49195 Primary Status: Current - Active

Address :
193 Jefferson Dr
MENLO PARK CA 94025-1114
SAN MATEO COUNTY

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