Dental Board of California
Licensing details for: 4290
Name: UNIVERSITY TOWNE DENTAL GROUP OF DR GUY W MENDIVIL,
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
4150 REGENTS PARK ROW, STE 130
LA JOLLA CA 92037
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MENDIVIL, GUY WILLIAM
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: MENDIVIL, GUY WILLIAM
License/Registration Type: Dentist License
License Number: 29737 Primary Status: Current - Active
Address :
11901 Bolthouse Dr
SUITE 200
BAKERSFIELD CA 93311-8455
