Jared Richard Fortman
InactiveCalifornia license 51826
License
- Licensed by
- Dental Board of California
- License number
- 51826
- Status
- Inactive (CurrentInactive)
- First issued
- October 6, 2003
- Expired
- October 31, 2026
- License holder
- Jared Richard Fortman
- Entity type
- Individual
Classifications
- Dental License Dental
More from the license record
- License type code
- 4401
Contact
5728 Evening Way
Santa Rosa, CA 95409-4347
Santa Rosa, CA 95409-4347
Sonoma County