Mary Hadisurya Patuwo
ActiveCalifornia license 36411
License
- Licensed by
- Dental Board of California
- License number
- 36411
- Status
- Active (Current)
- First issued
- January 20, 1989
- Expires
- August 31, 2028
- License holder
- Mary Hadisurya Patuwo
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
6112 Beach Blvd
Buena Park, CA 90621
Buena Park, CA 90621
Orange County