Medi-Cal Suspended and Ineligible Provider List...

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Dentist ProviderNumber

Abdelmalek, Ashraf #B33184 Suspended824 S. Alvarado Street indefinitely effectiveLos Angeles, California 7/12/91.

Abilez, Gilbert J., Jr. Suspended 3180 Willow Lane, indefinitely effectiveSuite 218 4/20/98.Westlake Village, California

Abusbitan, Abdulkadir 41576 Suspended Yousef indefinitely effective48 Park Plaza Drive, 3/1/2005.Suite #263Daly City, California

Acquaviva, Frederick D., #20982 SuspendedD.D.S. indefinitely effective120 Happy Valley Road 9/27/90.Santa Cruz, California

Adams, Karen Leona 90015 Suspended501 West Olympic indefinitely effective Boulevard, Apartment 811 12/30/01.Los Angeles, California

Adeli, Mojgan E. Suspended1129 27th Street indefinitely effectiveLos Angeles, California 7/20/98.

Akop, William D36512 Suspended1624 Glenmount Drive indefinitely effectiveGlendale, California 6/17/98.

Albarracin, Carlos Unlicensed SuspendedBusiness Manager indefinitely effective37730 53rd Street, East 6/20/05.Palmdale, California

Alhanati, Craig B32216 Suspended4226 S. Saviers Road, #9 indefinitely effectiveOxnard, California 6/7/94.

Anderson, Greg B30331 Suspended6 Red Feather Court indefinitely effectivePleasanton, California 4/3/95.

Arcadia Kids Dental Care Suspended638 West Duarte Road, indefinitely effectiveSuite #9 4/20/05.Arcadia, California

Ash-Slayter, Carolyn M. B34298 Suspended17212 Carranza Drive indefinitely effectiveSan Diego, California 10/14/93.

Atallah, Hassan Suspended 23930 Ocean Avenue, #15 indefinitely effectiveTorrance, California 6/18/98.


Badzik, Daniel R. B16463 Suspended 1530 3rd Street, Suite 201 indefinitely effectiveLincoln, California 6/19/95.

Baily, Robert C. D15457 Suspended200 N. Cumbre Road, indefinitely effectiveSuite G 4/8/96.Ventura, California

Ballard, Roger L. B15933 Suspended 3010862 Calle Verde, days effectiveSuite C 4/6/92.La Mesa, California

Banaga, Josefina M., 49277 SuspendedD.D.S. indefinitely effectiveJosefina Banaga Dental 6/14/2006. Clinic1818 South Western Avenue, #205Los Angeles, California and1200 North Vermont Avenue, DLos Angeles, California

Bautista, Maximillian 45822 Suspended532 Lanning Court indefinitely effectiveSan Jose, California 4/10/2007.

Bautista, Rolando B27954 Suspended565 East El Paso indefinitely effectiveFresno, California 6/17/96.

Bentley, David J. Suspended380 Waller Street indefinitely effectiveSan Francisco, California 10/20/03.

Berkowitz, Ronald, D.D.S. B18680 Suspended2020 Coffee Road, indefinitely effectiveSuite J4 7/31/93.Modesto, California

Berry, Scott T. D32927 Suspended605 State Street indefinitely effectiveSanta Barbara, California 1/27/99.

Berthelsen, Roger Lee 31895 Suspended180 East Palm Canyon indefinitely effective Drive 10/20/03 (old date).Palm Springs, California 4/10/2005 (new date).

Bevan, Warren Alexander 24746 Suspended2505 Samaritan Drive, indefinitely effectiveSuite 406 6/19/04.San Jose, California

Bina, Shokrollah B39233 Suspended3108 West Imperial Highway indefinitely effectiveInglewood, California 11/23/98.

Bingham, Charles B. B10796 Suspended500 No. Broadway, #18 indefinitely effectiveBlythe, California 9/14/92.

* License Number issued by the State Board of Dental Examiners

1 – Medi-Cal Suspended and Ineligible Provider ListMay 2007

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Dentists ProviderProviderNumber Number

Blue, Dennis Royal B24363 Suspended1245 Main Street indefinitely effectiveP.O. Box 2850 7/24/96.Weaverville, California

Borja, Benjamin D27240 Suspended2226 N. Manor Drive indefinitely effectiveSacramento, California 5/1/96.

Brinker, Richard Suspended2580 Jacklight indefinitely effectivePort Hueneme, California 8/12/96.

Burke, Errol, D.D.S. DL19271* Suspended7080 Hollywood indefinitely effective Boulevard, #1008 7/1/72.Los Angeles, California

Butko, Nathaniel K. B38808 Suspended5814 Jupiter Place indefinitely effectiveGardena, California 2/14/94.

Butler, David S. 20001 Suspended4236 Bonita Road indefinitely effectiveBonita, California 08/18/03.

Butt, Farida Rashid D38809 SuspendedHouse #85, Street #61 indefinitely effectiveF-10/3, Islamadad 6/18/98.Pakistan

Calhoun, Michael D34938 Suspended1438 Adobe Street indefinitely effectivePalm Springs, California 4/13/97.

Cambron, Otoniel Un- Suspended8995 San Gabriel Avenue licensed indefinitely effectiveSouth Gate, California 6/27/2006.

Cano, Felix F. B27508 SuspendedP.O. Box 1064 indefinitely effectiveCeres, California 11/18/99.

Chang, Steven Sun 39382 Suspended1721 Artesia Boulevard indefinitely effectiveGardena, California 11/19/04.

Chapple, Steven Allen, SuspendedD.D.S. indefinitely effective3172 South Arcadian 9/20/98. Shores RoadOntario, California

Cheng, Samuel K. 21356 Suspended2001 Barrington Avenue, indefinitely effectiveSuite 305 10/24/01.W. Los Angeles, California

Ching, Clayton V. B33266 Suspended146 S. Fairmont Boulevard indefinitely effectiveAnaheim, California 4/2/97.


Christian, Roy Paul 36212 Suspended990 West Fremont Avenue, indefinitely effectiveSuite #U-2 10/20/05.Sunnyvale, California

Cleymaet, Robert Victor 22209 Suspended9800 Topanga Canyon indefinitely effective Boulevard, Suite 146 09/19/02.Chatsworth, California

Choi, Seong Y. Suspended1575 Kiowa Crest Drive indefinitely effectiveDiamond Bar, California 6/18/98.

Chung, David Wayne B26612 Suspended4200 Trabuco Road, indefinitely effectiveSuite 120 11/9/93.Irvine, California

Cline, Darrell E. Suspended2717 18th S.E. indefinitely effectiveAuburn, Washington 8/3/95.

Cole, Edilia Campaneria 32672 SuspendedFolsom Family Dental indefinitely effective Center 6/22/02.6611 Folsom-Auburn Road, Suite MFolsom, California

Collins, Joseph D. 28529 Suspended1681 N. Waterman Avenue indefinitely effectiveSan Bernardino, California 9/17/92.

Comer, Michael J. Suspended8635 Elk Grove- Florin Road indefinitely effectiveElk Grove, California 12/9/96.

Crane, David Keith 30925 Suspended259 Meridian Avenue, #1 indefinitely effectiveSan Jose, California 06/11/04.

Curbelo, Sue Elena Suspended343 Pioneer Drive indefinitely effectivePark Towers, #702 9/14/05.Glendale, California

Cusimano, Christian C. 35481 SuspendedP.O. Box 1405 indefinitely effectiveBrea, California 3/3/2006.

Cutts, David P. B32230 Suspended40945 County Center Drive indefinitely effectiveTemecula, California 2/16/95.

Daguplo, Diosdado L. Suspended15923 Amar Road indefinitely effectiveLa Puente, California 5/20/01.

Dahler, Johan P. B22594 Suspended 1460 Washington indefinitely effective Boulevard, #B-201 11/12/93.Concord, California


1 – Medi-Cal Suspended and Ineligible Provider ListApril 2007

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Dambrose, Howard 37409 Suspended10715 Tierrasanta indefinitely effective Boulevard, Suite C 06/16/04.San Diego, California

Dansie, H. Boyd 27264 Suspended1701 W. March Lane, B indefinitely effectiveStockton, California 9/18/2006.

Dayan, M. Joshua D34688 Suspended1450 Cedar Place indefinitely effectiveLos Altos, California 1/24/96.

Delgado, Robert 25694 Suspended aka: Delgado, Roberto indefinitely effective217 South Serrano 12/29/01. Avenue, # 1Los Angeles, California

Del Mundo, Librada V., #24713 SuspendedD.D.S. indefinitely effective1404 North Alexandria 8/31/91. AvenueLos Angeles, California

Derboghosian, Roberto D31245 Suspended6801 Woodman indefinitely effectiveVan Nuys, California 3/14/97.

DiNozzi, Anthony David Suspended714 Kennedy Way indefinitely effectiveYoungwood, Pennsylvania 5/28/2003.

Dodson, William Francis 4970 Suspended880 Cass Street, #200 indefinitely effectiveMonterey, California 6/1/90.

Duffin, Steven R., D.D.S. CGP120755 Suspended41997 Tomahawk indefinitely effectiveAguanga, California 5/30/91.

Ebrahimian, Shahab 44473 Suspended1315 Carla Lane indefinitely effectiveBeverly Hills, California 9/3/2007.

Edalati, Bahman T. 48103 Suspended112 Tracy Court indefinitely effectiveAlamo, California 3/20/2007.

Ellenberger, John R., #23821 SuspendedD.D.S. indefinitely effective7107 Arlington Avenue, #l 12/6/90.Riverside, California

Engbretson, Wayne Allen 23822 Suspended15805 Avenida Venusta, indefinitely effectiveSuite 516 09/19/02.San Diego, California and14720 North SwanOro Valley, Arizona


Eslao, Caesar Suspended23067 Archibald Avenue indefinitely effectiveCarsen, California 2/14/96.

Esmenjaud, Erick 50408 Suspended Guillermo indefinitely effective14435 Hamlin Street, 5/7/2007.Suite #208Van Nuys, California

Fan, Allen Tso-Chiang 33134 Suspended871 South Atlantic indefinitely effective Boulevard 10/08/03.Monterey Park, California

Fayngor, Alexander, 31605 SuspendedD.D.S. indefinitely effective133 North Swall Drive, #102 9/22/04.Beverly Hills, California

Fayngor, Irina 34093 Suspended10496 Garvey Avenue indefinitely effectiveEl Monte, California 05/14/03.

Feder, Robert Dean 25253 Suspended4789 Songbird indefinitely effectiveChico, California 1/22/02.

Fifield, Perry Melvin 22347 Suspended9457 South 7000 East indefinitely effectiveSandy, Utah 08/18/03.

Finley, James 26633 Suspended3741 Olympiad Drive indefinitely effectiveLos Angeles, California 9/23/2004.

Flanagan, Hatti M. 13585 Suspended aka: Foley, Hatti M. indefinitely effective Flanagan, Hatti Maelynne 6/5/2005.7985 Santa Monica Boulevard, Suite #109West Los Angeles, California

Fordyce, Robert B12373 Suspended1214 12th Street indefinitely effectiveModesto, California 10/23/92.

Formaker, James W. D34487 Suspended1125 Pico Boulevard, #203 indefinitely effectiveSanta Monica, California 5/6/97.

Foster, Craig B25256 Suspended5000 Bechelli Lane, #104 indefinitely effectiveRedding, California 6/23/92.

Fox, Robert Lee, D.D.S. DC11128* Suspended3843 Howe Street, #6 indefinitely effectiveOakland, California 2/20/75.


1 – Medi-Cal Suspended and Ineligible Provider ListSeptember 2007

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Frankel, Gerard Sydney B14086 SuspendedThe Frankel Dental Group indefinitely effective Family Dentistry 7/14/01.9460 Beverly Hills Crest DriveBeverly Hills, California

Fredman, Lourya K., D.D.S. DX18323* Suspended2901 Wilshire Blvd., #201 indefinitely effectiveSanta Monica, California 9/21/74.Frier, Jill, D.D.S. B30347 Suspended238 Calle Laureles indefinitely effectiveSanta Barbara, California 12/4/93.

Fritz, Ronald E., D.D.S. #22731 SuspendedP.O. Box 881 indefinitely effectiveRancho Sante Fe, California 4/6/90.

Froh, John R. 21709 Suspended6213 Eisenhower Court indefinitely effectiveChino, California 7/20/01.

Gabriel, Tony Suspended909 East Windsor Road indefinitely effectiveGlendale, California 1/5/97.

Galvan, Anthony Halili 44173 Suspended aka: Halili, Anthony Galvan indefinitely effective Galvan, Anthony Halil 1/20/2006.4700 Tassajara Road,Apartment #3410Dublin, California and21001 San Ramon Valley Boulevard, Suite #C7San Ramon, California

Garcia, Gilberto B37667 Suspended128 Nieto Avenue indefinitely effectiveLong Beach, California 6/5/97.

Garcia, Miguel A. 37107 Suspended9334 Birch Bark Avenue indefinitely effectiveDowney, California 5/9/1999.

Gentile, Daniel F. 18470 Suspended11486 Phoebe Court indefinitely effectivePenn Valley, California 6/19/04.

Georgeson, Ronald M. B33090 Suspended 181 South Madera Avenue indefinitely effectiveKerman, California 2/19/98.

Gerodias, Eduardo 46799 Suspended Sabater indefinitely effective2800 Braden Avenue, 1/30/2007.Apartment #211Modesto, California

Ghilotti, Frank Robert 28155 Suspended1110 West Robinhood indefinitely effective Drive, Suite #100 3/3/2006.Stockton, California


Goldenberg, Jacob E. Suspended33000 North Highway 1 indefinitely effectiveFort Bragg, California 9/20/01.

Gonzalez, Thomas 26408 Suspended11506 East Broadway indefinitely effectiveWhittier, California 05/12/04.

Gougaloff, Roberto 40824 Suspended525 Main Street indefinitely effectiveEl Segundo, California 07/27/04.

Gray, Scott D. D36759 Suspended550 E. Latham Avenue indefinitely effectiveHemet, California 8/12/96.

Greer, David Thomas 32310 Suspended600 Coffee Road, Suite P indefinitely effectiveBakersfield, California 1/24/02.

Greethong, Kitiman 39154 Suspended123 Main Street indefinitely effectiveIrvine, California 2/20/02.

Gruer, Barry Howard 22359 Suspended2780 Cardinal Road, Suite B indefinitely effectiveSan Diego, California 12/29/01.

Guerra, Kimberly Lynn 50363 Suspended2621 Sheri Lane indefinitely effectiveLemon Grove, California 4/10/2005.

Gutgarts, Eliozar M. 32312 Suspended7865 Oceanus Drive indefinitely effectiveLos Angeles, California 1/24/02.

Gyaami, Opanin N. 33932 Suspended1012 Keystone Court indefinitely effectiveVacaville, California 7/20/04.

Hakanson, Mark Randall 26860 Suspended638 West Duarte Road, indefinitely effectiveSuite 9 06/19/03.Arcadia, California

Hall, Barry S., D.D.S. B35895 Suspended500 Calaveras Boulevard, indefinitely effective#341 2/14/96.Milpitas, California

Hamer, Robert L. 25897 Suspended553 Edgetown Avenue indefinitely effectiveOakdale, California 10/24/01.

Hamilton, Peder H. 24668 Suspended dba: Hamilton, Peder, indefinitely effective D.D.S.,Inc. 9/20/01.P.O. Box 111004Campbell, California

Han, Grace Suhui 42322 Suspended1126 N. Flower Street, indefinitely effectiveSuite C. 6/20/01.Santa Ana, California



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Hanna, George 31624 Suspended30645 Rue De La Pierre indefinitely effectiveLos Angeles, California 4/29/02.

Hanna, Sohair 37334 Suspended8914 S. Vermont Avenue indefinitely effectiveLos Angeles, California 8/29/2007.

Hansen, Robert E. Suspended aka: Robert E. Hausen indefinitely effective960 E. Green Street, #103 1/20/99.Pasadena, California

Harrell, Walter B24522 Suspended72-840 Hwy. 111, Suite 397 indefinitely effectivePalm Desert, California 12/15/95.

Harvey, Edward Lee 23193 Suspended744 Empire Street C, indefinitely effectiveSuite 103 12/20/98.Fairfield, California

Hashemi, Keyvan 39645 Suspended c/o 1087 Meredian indefinitely effective Avenue, Suite #30 11/20/2006.San Jose, California

Hassapakis, Craig L. Suspended2525 Iowa Avenue indefinitely effectiveModesto, California 7/19/01.

Hearvey, Rundal R. B30392 SuspendedP.O. Box 3812 indefinitely effectivePinedale, California 12/4/94.

Heller, Louis N., D.D.S. #8181 Suspended2506 American River Drive indefinitely effectiveSacramento, California 7/30/91.

Hess, Milton W. B11258 Suspended8809 Sunland Boulevard indefinitely effectiveSun Valley, California 9/14/92.

Higbee, Barry Tod D33589 Suspended24515 Alessandro indefinitely effective Boulevard 10/26/92.Sunnymead, California

Hobson, Donald A. 33099 Suspended107 W. Fairview Boulevard indefinitely effectiveInglewood, California 4/18/02.

Hoehn, James D. B33937 Suspended280 Northwest Lake indefinitely effective Boulevard, #205 8/29/95.West Lake Village, California

Hoffman, Ralph L., D.D.S. #14774 Suspended3769 San Rafael Way indefinitely effectiveRiverside, California 9/21/90.


Hopenstand, Boaz Jacob Suspended151 N. Willaman Drive indefinitely effectiveBeverly Hills, California 4/18/02.

Hosson, Victor B17935 Suspended4501 Trenton Road indefinitely effectiveSanta Rosa, California 10/18/95.

Hovis, Paul K. 019- Suspended7918 Reseda Boulevard, 018316 indefinitely effectiveApartment 202 8/20/01.Reseda, California

Hudson, Tedie L. Marth Suspended1340 Granada Avenue indefinitely effectiveSan Marino, California 6/27/96.

Ichiuju, Arnold T. Suspended17 San Marcos Court indefinitely effectiveSalinas, California 7/19/01.

Issacson, Yoram B38298 Suspended750 W. Alosta Avenue, indefinitely effective Suite F 11/12/99.Glendora, California

Jacobson, Dennis G. 38299 Suspended240 Newport Center Drive, indefinitely effectiveSuite #105 3/3/2006.Newport Beach, California

Jensen, Neil B18567 Suspended8515 Hans Engle Way indefinitely effectiveFair Oaks, California 11/12/93.

Jimenez, Marcelo B31291 Suspended1024 S. Glendale Avenue, indefinitely effective Suite A 9/14/92.West Covina, California

Johnson, Liza B30076 Suspended2643 Scotts Victor Drive indefinitely effectiveMoreno Valley, California 10/11/95.

Johnson, Robert S. 18715 Suspended72551 Greenbriar Lane indefinitely effectivePalm Desert, California 11/18/01.

Jones, Bradley C. 37678 Suspended1600 Trancas Street indefinitely effectiveNapa, California 11/19/04.

Jones, Bradley C. 37678 Suspended1600 Trancas Street, indefinitely effectiveSuite B 11/7/04.Napa, California

Ju, Yue Suspended178 Crestwood Drive, Apt. 6 indefinitely effectiveDolly City, California 10/20/03.

Kane, Burton Suspended28731 Shire Oaks Drive indefinitely effectiveRancho Palos Verdes, California 4/20/98.



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Kanemura, Gary Kazuo, 29960 SuspendedD.D.S. indefinitely effective630 South Fairmont Avenue, 07/14/04.Suite ALodi, California

Kazemipour, Reza M. Suspended1006 Judson Drive indefinitely effectiveMountain View, California 10/20/03.

Kelly, Andrew E. B35919 Suspended dba: Kelly Dental Group indefinitely effective6005 Le Doux Road 4/13/97.Los Angeles, California

Kelly, Pedapoodi J. B29323 Suspended130 N. Las Lunas Street indefinitely effectiveHemet, California 2/27/95.

Kelly, Pedapoodi Judson 29323 Suspended4816 Avenue N, indefinitely effectiveApartment #1 7/1/2006.Brooklyn, New York

Kennedy, Bill William 31646 Suspended5415 South Chariton Avenue indefinitely effectiveLos Angeles, California 03/04/03.

Kent, Donald E. 34133 Suspended1006 Myrtle Place indefinitely effectiveNovato, California 2/10/99.

Kent, Donald E. B34133 Suspendedc/o Over 60 Health Center indefinitely effective1860 Alcatraz Avenue 4/23/97.Berkeley, California

Kersten, Timothy Alan 26190 Suspended20484 Marquette Street indefinitely effectiveBurney, California 11/26/02.

Ketchum, Thomas A. B22236 Suspended74-965 Highway 111 indefinitely effectiveIndian Wells, California 6/3/94.

Khajavi, Azadeh 46841 Suspended13455 Granite Creek Road indefinitely effectiveSan Diego, California 3/3/2006.

Khosravi, Roksaneh Suspended24912 Oak Creek Lane indefinitely effectiveLake Forrest, California 12/20/98.

Kim, Dae Hyun Suspended12001 Darby Avenue indefinitely effectiveNorthridge, California 5/12/00.

Kim, Dae Hyun Suspended8100 Eastern Avenue indefinitely effectiveBell Gardens, California 10/20/01.


Kim, Sung Wook, D.D.S. 44326 Suspended17502 Kensington Circle indefinitely effectiveCerritos, California 9/20/05. and3460 Wilshire Boulevard,#104Los Angeles, California

Kohanchi, Behzad Suspended23454 Claredon Street indefinitely effectiveWoodland Hills, California 5/20/01.

Komaki, Keith Yoshikazu 22715 Suspended aka: Komaki, Keith indefinitely effective Yoshikuzu 7/20/2006.646 South Gentry LaneAnaheim, California

Krajian, John Albert 12895 Suspended10366 Wilshire indefinitely effective Boulevard, #3 06/24/04.West Los Angeles, California

Krajian, John Albert 12895 Suspended270 North Canon Drive, indefinitely effectiveApartment #1608 4/20/2005.Beverly Hills, California

Kushner, William III 42171 Suspended224 Promenade Lane indefinitely effectiveDanville, California 3/20/2007.

LaMothe, Richard M. B18725 Suspended2320 Woolsey Street indefinitely effectiveBerkeley, California 6/19/95.

Landis, Fred S., D.D.S. #10153 Suspended1282 Market Street indefinitely effectiveSan Francisco, California 7/30/91.

Larsen, Steven Alan, D.D.S. #28022 Suspended1559 West 11th Street indefinitely effectiveEscondido, California 5/21/90.

Lavi, Jacob Jonathan 38074 Suspended17200 Ventura Boulevard, indefinitely effectiveSuite #309 10/25/2006.Encino, California

Lee, Chang Soo 45132 Suspended114 North Ardmore Avenue indefinitely effectiveLos Angeles, California 6/25/03.



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Lee, Jonathon Jonghun 44919 Suspended aka: Lee, Jonathan Jonghun indefinitely effective266 South Harvard Boulevard, 6/25/03.Suite 110Los Angeles, California

Lee, Kyong Mu B32220 Suspended5772 Park West Circle indefinitely effectiveLa Palma, California 4/23/97.

Lee, Kyong Mu B3220 Suspended5105 East Florence indefinitely effective Avenue, #6 6/10/97.Bell, California

Lee, Won Koo 34367 Suspended aka: Won K. Lee 4/20/999405 York Road for 5 years.Monterey Park, California

Lien, Chun Yen 25739 Suspended1520 Kensington Road indefinitely effectiveSan Marino, California 12/15/2006.

Lim, Jhang Hyung B30384 Suspended9263 N. Saybrook Drive, D30384 indefinitely effective#239 5/6/97.Fresno, California

Loredo, Carolina Poblete 2779 Suspended811 North Dillon Street indefinitely effectiveLos Angeles, California 01/19/05.

Low, Eugene 19643 Suspended1161 Oxford Way indefinitely effectiveStockton, California 7/20/2006.

Luckey, John Suspended14962 Bear Valley 6, #275 indefinitely effectiveVictorville, California 6/10/96.

Manlapaz, Carlos 26202 Suspended Paredese indefinitely effective11395 Atlantic Avenue 11/19/04.Lynwood, California

Mansueto, Robert 25941 Suspended1301 Ynez Place indefinitely effectiveCoronado, California 6/5/2005.

Martinez, Daniel A. Suspended115 Ford Street indefinitely effectiveRedlands, California 2/20/02.

Masterson, Richard Chase Suspended544 North Main, Suite C indefinitely effectiveYreka, California 10/20/01.

Masueto, Robert F. B25941 Suspended1301 Ynez Place indefinitely effectiveCoronado, California 12/29/93.

Matcan, Kamal B30585 Suspended18701 Sherman Way D30585 indefinitely effectiveReseda, California 5/30/95.


Matheson, Robert L. D39682 Suspended10630 Towncenter Drive, indefinitely effective#131 12/20/98.Rancho Cucamonga, California

Maximilliano, Monica Unlicensed Suspended aka: Plasencia, Monica indefinitely effective Maximilliano, Monica Iriarte 4/20/05. Maximilliano, Monica Andrea2232 West Channing StreetWest Covina, California

Mayers, Ann Louise 31073 Suspended4110 Moorpark Avenue, indefinitely effectiveSuite #B 4/10/2005.San Jose, California and5480 Makati CircleSan Jose, California

Mays, David Willie, III B28040 Suspended7271 Engle Road, Suite 101 indefinitely effectiveMiddleburg Heights, Ohio 6/20/98.

McLaughlin, Harry L. Suspended9940 Kika Court, Apt. 4025 indefinitely effectiveSan Diego, California 2/23/95.

McLearan, Harold E. 20232 Suspended2804 East 30th Avenue indefinitely effectiveSpokane, Washington 12/15/2006.

McKinster, Michael 34382 Suspended7201 Adams Avenue indefinitely effectiveColton, California 12/13/99.

Medinnus, Mark Grant 33630 SuspendedP.O. Box 1836 indefinitely effectiveHayfork, California 12/18/02.

Melkonian, Roger W. 22528 Suspended5525 New Wellington Close indefinitely effectiveAtlanta, Georgia 4/21/92.

Memmott, Dana B. Suspended2601 E. 19th Street, #17 indefinitely effectiveSignal Hill, California 2/23/95.

Mesbah, Rahim 48961 Suspended4108 Mercer Drive indefinitely effectiveModesto, California 10/25/2006.

Misic, Petar R., D.D.S. #23261 Suspended 6010921 Wilshire Blvd., #6 #B23261 days effectiveLos Angeles, California 9/9/91.

Miyaji, Charles Suspended5027 August Street indefinitely effectiveSan Diego, California 7/20/98.

Moon, Russell 11617 Suspended12381 Wilshire Boulevard, indefinitely effectiveSuite 101 5/3/95.Los Angeles, California


1 – Medi-Cal Suspended and Ineligible Provider ListJuly 2007

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Moon, Russell B28767 Suspended12831 Wilshire Boulevard, indefinitely effectiveSuite 103 7/20/96.Los Angeles, California

Moore, David S. B30811 Suspended 1442 University Avenue indefinitely effectiveSan Diego, California 11/20/93.

Munoz, Alfredo Ex-Helmes B26489 Suspended446 North A Street indefinitely effectiveOxnard, California 10/23/92.

Nahigian, Stephen J. 28051 Suspended23440 Civic Center Way, indefinitely effectiveSuite #201 4/11/2007.Malibu, California

Navarro, Claudia Brandi RDH Suspended aka: Dent, Claudia P. 17349 indefinitely effective Navarro, Claudia P. 3/20/2006.3424 Paula StreetWest Covina, California

Nelson, Dorothy S. Suspended295 San Francisco Way indefinitely effectiveDaly City, California 1/5/97.

Njo, Michael Allan 37716 Suspended1510 Railroad Avenue indefinitely effectiveSt. Helena, California 3/3/2006.

Nguyen, Anh H. 38103 Suspended3914 N.E. 80th Avenue indefinitely effectivePortland, Oregon 12/14/92.

Nguyen, Trieu H. Suspended625 E. Valley Boulevard, indefinitely effective Suite K 12/20/98.San Gabriel, California

Nguyen, Trung Dung 43051 Suspended aka: Nguyen, Trung indefinitely effective705 Colton Avenue 2/28/06.Colton, California

Nichols, Marcus F. Suspended5836 Canterbury Drive indefinitely effectiveCulver City, California 05/21/00.

Nunez, Pete D. D23654 Suspended aka: Pete Dunez indefinitely effective3542 East Adams Street 6/4/99. (old date)Fresno, California

Nunez, Pete D. D23654 Suspended3542 East Adams indefinitely effectiveFresno, California 4/5/2007 (new date)

O’Brien, James Patrick 27469 Suspended2177 Ventura Boulevard indefinitely effectiveCamarillo, California 10/13/04.


Ortega, Jesus Robert 26500 Suspended924 Fairway Avenue indefinitely effectiveUkiah, California 4/2/03.

Owyang, Alva 15753 Suspended21 Tennis Club Drive indefinitely effectiveDanville, California 2/20/2007.

Padgett, James R. B30735 Suspended2211 Garfias Drive indefinitely effectivePasadena, California 6/17/96.

Pak, Jae S. B39061 Suspended dba: Dr. Pak Dental Group indefinitely effective617 S. Main Street 4/7/97.Santa Ana, California

Pak, John Won Chai Suspended1255 East Province Drive indefinitely effectiveFresno, California 9/14/01.

Parker, Bruce E. 29930 Suspended2530 N.W. Medical Park indefinitely effective Drive 12/30/01.Roseburg, Oregon

Petersen, Kirk J. Suspended777 Bellflower Boulevard, indefinitely effective#105 3/16/95.Long Beach, California

Peterson, David E. B17367 Suspended 15434 Hickory Drive, #3411 days indefinite Box 3411 R.E.M.A. 12/29/93.Lyons, Colorado

Pine, Michael J. B25189 Suspended15316 Ocean View Drive indefinitely effectiveBrookings, Oregon 2/27/95.

Pinto, Luis Alexandrino 49189 Suspended17 Weepingwood indefinitely effectiveIrvine, California 11/20/2006.

Plasencia, Zubin Suspended aka: Pugliese, Zubin indefinitely effective2232 West Channing Street 4/20/05.West Covina, California



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Plinck, William E. B16611 Suspended224 Canada indefinitely effectiveSan Clemente, California 12/23/92.

Price, Steven Vance B32606 Suspended13416 Stanford Avenue indefinitely effectiveLos Angeles, California 3/6/97.

Pryor, Cornelius, III B35538 Suspended3733 Olympiad Drive indefinitely effectiveLos Angeles, California 5/28/96.

Quan, Wesley Kirk 32923 Suspended175 South El Molina indefinitely effective Avenue, #7 10/15/2005.Pasadena, California

Quevedo, Jose Carlos Suspended c/o Ricardo Rodriguez, indefinitely effective D.D.S. 06/30/04.2465 West Whittier Boulevard, Suite 101Montebello, California

Rahmati, Behnam Suspended18 Misty Creek Lane indefinitely effective Laguna Hill, California 4/27/93.

Ramirez, Ralph B33714 Suspended3799 Muirfield Street indefinitely effectiveEl Monte, California 6/27/96.

Ramos, Carlos Suspended7383 Canyon Peak Lane indefinitely effectiveSan Diego, California 2/19/98.

Ramu, Nalaya Suspended1520 Camden Avenue, indefinitely effectiveApartment 106 2/20/02.Los Angeles, California

Rashti, Kouros Suspended18324 Clark Street, #322 indefinitely effectiveTarzana, California 2/20/02.

Ravanera, Rudolpho 37727 Suspended aka: Ravanera, Rodolfo indefinitely effective3700 Brunswick 12/29/01.S. San Francisco, California

Refoua, Tannaz 42876 Suspended and/or indefinitely effectiveKids and Adults Dental Care 10/20/04.2625 East Florence Avenue,Suite CHuntington Park, California

Rens, Robert B16621 Suspended7334 Girard Avenue, #104 indefinitely effectiveLa Jolla, California 12/3/95.


Riazi, Ali Motamed 38590 Suspended9899 Santa Monica indefinitely effective Boulevard, #457 8/20/02.Beverly Hills, California

Ridgley, Harry 16250 SuspendedP.O. Box 73492 indefinitely effectivePuyallup, Washington 6/21/02.

Righetti, Gerald L. B27192 SuspendedP.O. Box 1020 indefinitely effectiveSoledad, California 11/18/99.

Ritter, Lawrence J. B29436 Suspended6024 San Juan Avenue indefinitely effectiveCitrus Heights, California 3/1/94.

Rivera, Maria Corzon B26223 Suspended7759 California Avenue indefinitely effectiveRiverside, California 12/11/92.

Robles, Allen Suspended895 Burnett Avenue indefinitely effectiveSan Francisco, California 3/18/99.

Rocha, Mark D35541 Suspended8-581 Highway 371, #D indefinitely effectiveAnza, California 9/14/98.

Rodriguez, Ricardo 40880 Suspended9103 Tweedy Lane indefinitely effectiveDowney, California 3/20/05.

Rogers, Steven J. 38740 Suspended1774 Merill Road indefinitely effectiveParadise, California 10/20/03.

Rogers, Terri L. 37599 Suspended6222 W. Manchester Avenue, indefinitely effectiveSuite B 1/20/02.Los Angeles, California

Rollins, Maurice 20260 Suspended162 Wall Street indefinitely effectiveSonora, California 8/22/03.

Romero, Charles J. B19802 Suspended3055 S. High Street D19802 indefinitely effectiveDenver, Colorado 12/27/95.

Rosenberg, Craig B24596 Suspended5112 Warner Avenue, indefinitely effective Suite 101 12/3/95.Huntington Beach, California



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Ryan, Donald Vincent 24055 Suspended5904 North El Dorado indefinitely effective Street, Suite #C 12/28/2005.Stockton, California

Sacks, Irving B. 24056 Suspended703 Etheldore Street indefinitely effectiveMoss Beach, California 05/18/00.

Sakellariou, Constantine 32900 Suspended George indefinitely effective89 Golden Hinde Boulevard 9/22/2004.San Rafael, California and750 Las Gallinas, #216San Rafael, California

Santucci, Gerald D31376 Suspended1675 Alhambra Boulevard indefinitely effectiveSacramento, California 6/10/96.

Saraiva, Williams Defreitas 49405 Suspended1318 Wycliffe indefinitely effectiveIrvine, California 12/28/05.

Saraos, Nestor W. Suspended4329 Multnomath Street indefinitely effectiveLos Angeles, California 06/19/03.

Satow, Deane G. B22840 Suspended1433 Torrington Court indefinitely effectiveSan Jose, California 1/15/97.

Sattari, Pari Azim 41994 Suspended aka: Sattari, Pari Nazi indefinitely effective6163 Tampa Avenue 12/9/04.Tarzana, California

Schaubel, James August 35545 Suspended2701 East Alameda indefinitely effective Avenue, Suite #306 4/11/2007.Burbank, California

Schultz, Mark David 39705 Suspended212 Linden Street indefinitely effectiveSanta Cruz, California 12/15/2006.

Scordakis, Peter B37058 Suspended9216 Kiefer Boulevard, #2 indefinitely effectiveSacramento, California 1/19/94.

Seims, W. G., Jr. B10183 Suspended405 Center Street indefinitely effectiveYuba City, California 11/19/91.


Shafa, Farhad 44538 Suspended9313 Monter Mar Drive indefinitely effectiveLos Angeles, California 9/3/2007.

Shah, Aasim 46960 Suspended2825 Plaza Del Amo, #114 indefinitely effectiveTorrance, California 4/11/2007.

Shah, Kamlesh 34557 Suspended7057 Gaskin Place indefinitely effectiveRiverside, California 04/15/04.

Shah, Shailesh Rasik 38918 Suspended14082 Andy Place indefinitely effectiveRiverside, California 6/13/2003.

Sharaf, Nissan R. 42497 Suspended7471 Melrose Avenue, indefinitely effectiveApartment #15 11/20/2006.Los Angeles, California

Shaw, Michael P. B35996 Suspended1045 Poda Court 111 indefinitely effectiveFremont, California 6/1/95.

Singh, Tarvinder 29470 Suspended591 LeeAnn Avenue 2/20/00Yuba City, California for 10 years.

Singh, Tarvinder 29470 Suspended aka: Bhatti, Tarvinder indefinitely effective591 LeeAnne Avenue 03/07/03.Yuba City, California

Sisily, Sisson B29471 Suspended6363 Christie Avenue, indefinitely effective#2115 2/28/92.Emeryville, California

Skorupko, Vadim 41216 Suspended 5460 Dellwood Way, indefinitely effectiveSuite A 11/19/02.San Jose, California

Slack, Roy G. B10015 Suspended1334 Garnet Street, #3 indefinitely effectiveSan Diego, California 1/28/92.

Slattery, Thomas B16272 Suspended7511 Fairway Two Avenue indefinitely effectiveFair Oaks, California 4/9/96.

Smith, Gordon B28240 Suspended4141 Redondo Beach indefinitely effective Boulevard 1/28/92.Lawndale, California



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Smith, Scott Don D24406 SuspendedP.O. Box 1417 indefinitely effectiveWestwood, California 7/25/98.

Snipes, Stephen C. D30482 Suspended629 Rancho Santa Fe indefinitely effectiveSan Marcos, California 1/16/97.

Starinieri, Giancarlo 37741 Suspended4305 Torrance Boulevard indefinitely effectiveTorrance, California 4/17/2006.

Strawder, Richard B23674 Suspended6880 Carell Avenue indefinitely effectiveAgoura Hills, California 11/23/94.

Sturtz, Renate E. Suspended13723 Boquita Drive indefinitely effectiveDel Mar, California 10/1/97.

Tanner, Clelen C., D.D.S. B26003 Suspended21911 Foothill Boulevard indefinitely effectiveHayward, California 9/28/90.

Tarifard, Seyed 50380 Suspended Mohammad indefinitely effective3841 Vancouver Circle 11/20/2006.Stockton, California

Tarr, Ernest G90391 Suspended277 South Santa Fe Road, #5 indefinitely effectiveSan Marcos, California 1/28/92.

Taylor, Tamra Suspended629 Camino de los Mares, #102 indefinitely effectiveSan Clemente, California 11/16/95.

Thi, Hong Nga, D.D.S. 47429 Suspended925 East San Antonio indefinitely effective Drive, #14 4/6/2007.Long Beach, California

Thomas, Danny L. B34781 Suspended11560 Cozumel Avenue indefinitely effectiveCypress, California 7/20/98.

Thomassen, John A., D.D.S. 24512 Suspended9409 Thornton Road indefinitely effectiveStockton, California 2/17/84.

Thomassen Jr., Paul R. 11658 Suspended111 Camaritas Avenue indefinitely effectiveS. San Francisco, California 12/29/01.

Thompson, Florian B41797 Suspended4069 Athenian Way indefinitely effectiveLos Angeles, California 1/5/97.

Topal, Kathleen Dawn 35312 Suspended8194 Kramer Court indefinitely effectiveRedding, California 5/19/2006.


Townsend Leo W. B39120 Suspended dba: Laguna View Family indefinitely effective Dental 4/13/97.7915 Laguna Boulevard, Suite 120Elk Grove, California

Tracy, James B28398 Suspended3131 S. Bascon Avenue, D28398 indefinitely effectiveSuite 1 5/6/97.Campbell, California

Tran, Hoang T., D.D.S., Inc. SuspendedDental Corporation indefinitely effective101 West Grangeville 7/20/2006. BoulevardHanford, California

Tran, Hoang Trang Thai 45041 Suspended2810 South Rova Court indefinitely effectiveVisalia, California 6/20/2006. Truta, Marianne P. 32998 Suspended1860 El Camino, Suite 300 indefinitely effectiveBurlingame, California 2/18/99.

Uniat, Joseph B15603 Suspended140 Folsom Road indefinitely effectiveRoseville, California 6/3/94.

Valentine, Julie Suspended aka: Valentine, Najla indefinitely effective300 South Beverly Drive, Suite 401 10/20/01.Beverly Hills, California

Vaziri, Charles B38616 Suspended11980 San Vincente indefinitely effective Boulevard, Suite 901 7/20/98.Los Angeles, CA

Verne, Serge V. 38144 Suspended4510 Executive Drive, indefinitely effectiveSuite 210 05/08/03.San Diego, California



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Vo, Hong Nga Thi 47429 Suspended4050 Madelia Avenue indefinitely effectiveSherman Oaks, California 4/26/2007.

Vogler, Robert B166659 Suspended11455 E. Carson Street, indefinitely effectiveSuite 7 6/3/94.Lakewood, California

Vrenon, Paul Eric 44797 Suspended8650 West Spring indefinitely effective Mountain Road, #101 3/1/2005.Las Vegas, Nevada

Vu, Johnathan Andrew 50014 Suspended7251 Carlton Avenue indefinitely effectiveWestminster, California 4/26/2007.

Vu, Tri Duy 47011 Suspended4865 Rue Tours Court indefinitely effectiveSan Jose, California 12/6/2006.

Walker, Jimmie, Jr. 25304 Suspended2105 Stacia Way indefinitely effectiveSacramento, California 12/28/2005.

Wallace, John D. Jr., #22186 SuspendedD.D.S. indefinitely effective9913 Mission Gorge 12/8/88. Road, #1Santee, California

Ward, Douglas Austin 29518 Suspended aka: Ward, Douglas indefinitely effective Austin Garfield 8/20/02.CDC #20192California State Prison44750 60th Street WestLancaster, California

Ward, Douglas Austin 29518 Suspended Garfield indefinitely effective4904 19th Street 06/21/02.Lubbock, Texas

Whedbee, Joseph I. B30703 Suspended106 San Jacinto Street indefinitely effectiveRedlands, California 2/20/02.

Wolken, Stan C., D.D.S. CGP072015 Suspended2100 Carlmont Drive, #6 #22568 indefinitely effectiveBelmont, California 12/6/90.


Wong, Kai Wing B29749 Suspended1776-A Arnold Industrial indefinitely effectiveConcord, California 6/7/94.

Wong, Norman K. B11342 Suspended 543 East Vine Street indefinitely effectiveWest Covina, California 3/17/98.

Worrell, Blake B18956 Suspended478 W. Putnam, Suite 3 indefinitely effectivePorterville, California 11/18/94.

Wright, Lee Doris B14214 Suspended 3015 Grass Valley Street indefinitely effectiveColfax, California 11/12/93.

Yang, Sheng J. 40325 Suspended9869 Pawlet Circle indefinitely effectiveFountain Valley, California 1/19/05.

Yee, Robert Randall B23078 Suspended2204 16th Street indefinitely effectiveSacramento, California 5/10/97.

Yoo, In Joon Suspended aka: Bernard In Joon Yoo indefinitely effective320 Noren Street 7/20/98.La Canada, California

Zingheim, William B17418 Suspended333 S. Rancho Santa Fe indefinitely effective San Marcos, California 2/27/92.

Pedodontist

Harvey, Edward Lee B23193 Suspended104 Syne Court indefinitely effectiveSuisun City, California 12/20/98.


1 – Medi-Cal Suspended and Ineligible Provider ListJune 2007

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Unlicensed Dentist ProviderNumber

Avila, Juan Carlos Unlicensed Suspended aka: Gallo, Juan indefinitely effective Carlos Avila 07/06/04.6215 Orchard Avenue, Apt. BBell, California and3559 Gage Avenue, Apt. HBell, California

Villareal, Daniel Lara Unlicensed Suspended8397 Fountain Avenue, indefinitely effective#206 07/20/04.Los Angeles, California

Registered Dental Hygienist

Moreno, Daniel Dizon 6702 Suspended2608 Burdick Way indefinitely effectiveSan Jose, California 12/20/98.

Teague, Jenette 13245 Suspended2118 S. Victoria Avenue indefinitely effectiveLos Angeles, California 9/20/01.

Dental Assistant

Embrey, Christina 45766 Suspended1241 Howard Street indefinitely effectiveKingsberg, California 7/12/2006.

Gonzalez, Shirley Dean 54104 SuspendedP.O. Box 2763 indefinitely effectiveCarmichael, California 3/1/2005.

Guerrero, Irene Mary 61956 Suspended aka: Ramirez, Irene Mary indefinitely effective50-641 Sunburst Street 2/01/2007.Coachella, California

Lopez, Lisa Renee 56065 Suspended aka: Lopez, Lisa Renee indefinitely effective Navarro 4/26/2007.26 La CadenaSanta Barbara, California

Macall, Karen Maybel 46867 Suspended aka: Recinos, Karen indefinitely effective Mabel 7/12/2006. Guleserian, Karen Mabel Mabel, Karen McCall, Karen Mabel McCall-Guleserian, Karen Mabel Recinos, Karen22212 Wildwood PlaceChatsworth, California

Dental Assistant ProviderNumber

Morales, Orbelina Luz 61983 Suspended13008 Woodbridge Avenue indefinitely effectiveLa Mirada, California 7/20/05.

Orozco, Melissa Christine 58061 Suspended81-592 Santa Clara Court indefinitely effectiveIndio, California 9/20/2006.

Sanders, Janet Gwen 63899 Suspended aka: Romines, Janet indefinitely effective Bear, Janet Gwen 1/30/2007.5560 West MallAtascadero, California

Scarberry, Maureen 23136 Suspended I.D. #X09262 indefinitely effective c/o Leo Chesney Center 6/20/2006.P.O. Box 66Live Oaks, California

Siegfried, Kori Ann 47062 Suspended446 26th Street, 4th Floor indefinitely effectiveSan Diego, California 9/30/2005.

Tous, Denise Arlene 6808 Suspended aka: Howl, Denise Arlene indefinitely effective Bonella, Denise Arlene 4/24/2007. Sparagino, Denise Arlene3541 Soda Springs CourtOntario, California


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Registered Dental ProviderAssistant Number

Ayala, Alfredo 55226 Suspended6204 California Avenue indefinitely effectiveBell, California 6/10/2006.

Cantu, Atilano Paul 48964 Suspended505 18th Street, indefinitely effectiveApartment #3 5/12/2006.Bakersfield, California

Carillo, Barbara Suspended1429 Rose Avenue indefinitely effectiveSelma, California 5/12/2006.

Clark, Wendy M. 59122 Suspended1327 White Drive indefinitely effectiveSanta Clara, California 3/3/2006.

Danner, Nicola Marie 51113 Suspended aka: Howell, Nicole Marie indefinitely effective4855 60th Street West 9/30/2005.Rosamond, California

Dunn, Rebecca Frances 49860 Suspended3424 Kentucky Lane indefinitely effectiveCorona, California 5/30/2007.

Fu, Jack 62671 Suspended1375 Holland Court indefinitely effectiveSan Jose, California 5/12/2006.

Groce, Lori Jean 47234 Suspended Marie indefinitely effective1170 Georgia Street 12/15/2006.Imperial Beach, California

Henry, Donna Louise 68326 Suspended1010 East Bobier Drive, indefinitely effective#32 5/28/2007.Vista, California

Keaton, Kathleen Susan 54731 Suspended20236 Lago Street indefinitely effectiveRedding, California 12/15/2006.

Leandro, Danna Michelle 24684 SuspendedP.O. Box 163 indefinitely effectiveBethel Island, California 8/20/98.

Llamas, Laura Ramirez 52917 Suspended18335 East Renwick Road indefinitely effectiveAzusa, California 3/03/2006.Mata, Angela Marie 55857 Suspended210B East Tergallas Road indefinitely effectiveAntioch, California 9/30/2005.

Malm, Maureen Anna 68344 Suspended aka: Johnson, Maureen indefinitely effective Bond, Maureen Anna 6/5/2007. Johnson, Marie Anna617 Breey WayOrange, California


Mantle, Linda Gay 55871 Suspended aka: Larkin, Linda indefinitely effective Larkin, Linda Gay 6/3/2007. Mantle, Linda Mare, Laurie Ash, Shirley124 W. 225th StreetCarson, California

McCann, Nadine Marie 46868 Suspended3153 Mary Street indefinitely effectiveRiverside, California 12/15/2006.

McMaster, Megan K. 61508 Suspended1111 Railroad Avenue, #25 indefinitely effectiveYuba City, California 6/3/2007.

Palacios, Jose E. 34033 Suspended15454 Hutchcroft Street indefinitely effectiveLa Puente, California 5/19/2006.

Perkins, Carla 46339 Suspended16862 Downey Avenue indefinitely effectiveParamount, California 9/30/2005.

Pfeiffer, Sherry Ann 52142 Suspended1523 High Meadows Drive indefinitely effectiveBeaumont, California 3/3/2006.

Saybe, John G. 50714 Suspended480 90th Street, #102 indefinitely effectiveDaly City, California 1/29/2007.

Scarbery, Maureen 23136 Suspended Therese indefinitely effective aka: Baker, Maureen 6/20/2006. Therese Scarberry, Maureen23350 Live Oak RoadWillits, California

Shields-Walker, Susan 51110 Suspended Beth indefinitely effective5231 Meadowview Drive 9/30/2005.Camarillo, California

Stengel, Toffiny Anne 59066 Suspended2145 Los Gatos-Almaden indefinitely effective Road 6/5/2007.San Jose, California



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Vidriales-Gurule, Vivian J. 46364 Suspended aka: Gurule, Vivian J. indefinitely effective16021 Via Arroyo 3/03/2006.San Lorenzo, California

West, Lisa Louise 57191 Suspended25524 Cheryle Street indefinitely effectiveBarstow, California 12/15/2006.

Wyman, Arlene Marie 46124 Suspended aka: Ackerman, Arlene indefinitely effective Marie 6/6/2007. Olson, Arlene Marie940 Sturbridge DriveLa Habra, California

Yee, Randall Allan 49283 SuspendedInmate Number P 86566 indefinitely effective c/o California Men's 7/7/2000. ColonyDorm 18-25UP.O. Box 8101San Luis Obispo, California

Zeigler, Alishia Marie 48627 Suspended aka: Graham, Alishia indefinitely effective Marie 1/29/2007.2130 Ahneita DrivePleasant Hill, California

Zipprich, Suzanne 55864 Suspended9192 Sherry Drive indefinitely effectiveHuntington Beach, 9/30/2005.California

Dental Clinic ProviderNumber

Alosta Family Dental G91696 Suspended750 West Alosta, Suite F indefinitely effectiveGlendora, California 10/20/02.

Blossom Hill Dental Care Suspended5460 Dellwood Way, Suite A indefinitely effectiveSan Jose, California 05/20/03.

Kids and Adults Dental 42876 Suspended Care indefinitely effective and/or 10/20/04.Refoua, Tannaz2625 East Florence Avenue,Suite CHuntington Park, California

Northridge Dental Suspended8349 Reseda Boulevard indefinitely effectiveNorthridge, California 12/18/03.

Valer, Enrique Suspended aka: Valer, Raul indefinitely effective Enrique Franco 06/30/04. Valer, Raul Alberto Solis Pebe, Rulman Valer, Paul Salina, Victor and/orMillennium Dental9800 Pangborn AvenueDowney, California

Palm Canyon Dental 4016 Suspended180 East Palm Canyon indefinitely effective Drive 01/20/04.Palm Springs, California

Wishart, Donald E. 24622 Suspended5150 Graves Avenue, indefinitely effectiveSuite 12C 05/07/03.San Jose, California

Yatrofsky, Steven D., D.D.S. 2745 Suspended12372 Baja Panorama indefinitely effectiveSanta Ana, California 06/20/03.


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