Dental Board of California
Licensing details for: 7659
Name: CHILDREN'S DENTAL FUN ZONE, DENTAL GROUP OF CAMILA BORRERO, DDS,
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: CHILDREN'S DENTAL FUN ZONE III
Address of Record
569 W LOWELL BOULEVARD
TRACY CA 95376
SAN JOAQUIN county
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License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RODEF, FARIBORZ
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BORRERO FONSECA, MARIA CAMILA
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: Borrero Fonseca, Maria Camila
License/Registration Type: Dentist License
License Number: 51046 Primary Status: Current - Active
Address :
569 W LOWELL AVE
STE 200
TRACY CA 95376
SAN JOAQUIN 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: 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
