Dental Board of California
Licensing details for: 4347
Name: COUNTRY FAIRE DENTAL GROUP, SUDHA CHINTA, DDS,
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
12111 ALCOSTA BLVD
SAN RAMON CA 94583
CONTRA COSTA county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHINTA, SUDHA
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHINTA, SUDHA SESHA
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: CHINTA, SUDHA SESHA
License/Registration Type: Dentist License
License Number: 43769 Primary Status: Current - Active
Address :
103 SYCAMORE VALLEY ROAD WEST
DANVILLE CA 94526
CONTRA COSTA COUNTY
