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Licensing details for: 6656

Name: CULVER DEL REY DENTAL CENTER, DR. PALMER AND DR. BRAND DENTAL OFF

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Partnership

Previous Names: CULVER DEL REY DENTAL CENTER

Address of Record

12202 W. WASHINGTON BLVD.
LOS ANGELES CA 90066
LOS ANGELES county
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Issuance Date

January 15, 2007

Expiration Date

November 30, 2014

Current Date / Time

June 6, 2025
1:43:9 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: PALMER, PAUL BRIAN

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: PALMER, PAUL BRIAN

License/Registration Type: Dentist License

License Number: 28603 Primary Status: Current - Inactive

Address :
23569 Sunnymead Ranch Pkwy
ste A
MORENO VALLEY CA 92557-2884
RIVERSIDE COUNTY

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