Dental Board of California
Licensing details for: 5814
Name: ENCINO COSMETIC AND IMPLANT DENTAL GROUP,
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
16133 VENTURA BLVD, STE 1100
ENCINO CA 91436
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PROUSSAEFS, PERIKLIS THEODORE
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: PROUSSAEFS, PERIKLIS THEODORE
License/Registration Type: Dentist License
License Number: 45310 Primary Status: Current - Active
Address :
3585 TELEGRAPH ROAD
SUITE C
VENTURA CA 93003
VENTURA COUNTY
