Dental Board of California
Licensing details for: 4560
Name: SOUTHLAND DENTAL GROUP, ANTOINE SOURIALLE, DDS, INC
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
399 E HIGHLAND AVE, STE 120
SAN BERNARDINO CA 92404
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SOURIALLE, ANTOINE S
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SOURIALLE, ANTOINE ONSI
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: SOURIALLE, ANTOINE ONSI
License/Registration Type: Dentist License
License Number: 44093 Primary Status: Current - Active
Address :
399 E Highland Ave
Suite 120
SAN BERNARDINO CA 92404-3808
SAN BERNARDINO COUNTY
