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Licensing details for: 404

Name: SURYAWALA, URVA

License Type: Pediatric Minimal Sedation Permit

Primary Status: Current - Active

Address of Record

11834 Greenbrier Ln
GRAND TERRACE CA 92313-8341
SAN BERNARDINO county
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Practice Location

18564 OUTER HWY 18 N #301
APPLE VALLEY CA 92307
SAN BERNARDINO county
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Issuance Date

February 7, 2025

Expiration Date

November 30, 2025

Current Date / Time

June 6, 2025
9:57:38 AM

License Relationships

PMS to DDS or OMS or SP

License/Registration Role: Pediatric Minimal Sedation Permit

Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit

Name: SURYAWALA, URVA

License/Registration Type: Dentist License

License Number: 107035 Primary Status: Current - Active

Address :
11834 GREENBRIER LANE
GRAND TERRACE CA 92313
SAN BERNARDINO COUNTY

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