Dental Board of California
Licensing details for: 5613
Name: HUB PLAZA DENTAL GROUP, JACKSON AND MOORE DENTAL CORP.
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
1047 Harriman Pl Ste B
SAN BERNARDINO CA 92408-4203
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MOORE, ANDREA CHRISTIANE
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JACKSON, TANISHA ANJANETTE
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MOORE, ANDREA
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JACKSON, TANISHA
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: MOORE, ANDREA CHRISTIANE
License/Registration Type: Dentist License
License Number: 48337 Primary Status: Current - Active
Address :
1875 N Campus Ave
UPLAND CA 91784-8208
SAN BERNARDINO 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: JACKSON, TANISHA ANJANETTE
License/Registration Type: Dentist License
License Number: 47103 Primary Status: Current - Active
Address :
422 Orange St
REDLANDS CA 92374-3206
SAN BERNARDINO COUNTY
