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Licensing details for: 102692

Name: NAMM, JUSTIN KIRK

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Address of Record

12920 Puesta Del Sol St
REDLANDS CA 92373-7444
SAN BERNARDINO county
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Practice Location

1221 N State St
Suite D
SAN JACINTO CA 92583-6322
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Issuance Date

July 2, 2018

Expiration Date

October 31, 2027

Current Date / Time

December 13, 2025
4:48:42 PM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Related Party Role: Additional Office Permit

Name: JUSTIN NAMM DENTAL CORPORATION

License/Registration Type: Additional Office Permit

License Number: 81513 Primary Status: Current - Active

Address :
1221 STATE ST SUITE D
SAN JACINTO CA 92583
RIVERSIDE COUNTY

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FNP to DDS or OMS

License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Related Party Role: Fictitious Name Permit

Name: DENTISTS OF SAN JACINTO DENTAL GROUP, JUSTIN NAMM DENTAL CORPORATION

License/Registration Type: Fictitious Name Permit

License Number: 17644 Primary Status: Current - Active

Address :
1221 STATE ST SUITE D
SAN JACINTO CA 92583
RIVERSIDE COUNTY

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