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Get Referral Service - Dental Board Of California - State Of California - Dbc Ca

TION FOR REFERRAL SERVICE Business and Professions Code Sections 650, 650.2, 651, 1680 NO FEE FOR OFFICE USE ONLY RS Issue Date Please type or print legibly Name of Referral Service: Address of Referral Service: (Street) Telephone No. (City) Referral Service is owned and operated by: Individual dentist Group of dentists Dental Society Other (describe): Fax No. (State) (Zip Code) Individual Unlicensed partnership General Corporation Is Referral Service a Knox-Keene Provider or Associa.

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