Dental Board of California
Licensing details for: 4899
Name: CHILDREN'S DENTAL FUN ZONE, DENTAL PRACTICE OF
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
151 S MEDNIK AVE
EAST LOS ANGELES CA 90022
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TO, MICHELLE P
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RODEF, FARIBORZ
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: RODEF, FARIBORZ
License/Registration Type: Dentist License
License Number: 38356 Primary Status: Current - Active
Address :
2233 E GARVEY AVE N
WEST COVINA CA 91791
LOS ANGELES COUNTY
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: TO, MICHELLE P
License/Registration Type: Dentist License
License Number: 46337 Primary Status: Current - Active
Address :
12128 Vanowen St
NORTH HOLLYWOOD CA 91605-5651
LOS ANGELES COUNTY
