Dental Board of California
Licensing details for: 9212
Name: SHIELDS FAMILY DENTISTRY, DENTAL OFFICE OF EDGAR D. ROQUE, DDS, I
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: SHIELDS FAMILY DENTISTRY
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ROQUE, EDGAR DONES
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: ROQUE, EDGAR DONES
License/Registration Type: Dentist License
License Number: 55681 Primary Status: Current - Active
Address :
420 W. SHIELDS AVE
FRESNO CA 93705
FRESNO COUNTY
