Dental Board of California
Licensing details for: 105741
Name: PHAM, PETER NGUYEN
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
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: PETER PHAM, DDS
License/Registration Type: Additional Office Permit
License Number: 82916 Primary Status: Current - Active
Address :
16748 Golden Valley Parkway
LATHROP CA 95330
SAN JOAQUIN COUNTY
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: Lathrop Modern Dentistry, Dental Group of Lathrop Modern Dentistry, Prof. Corp.
License/Registration Type: Fictitious Name Permit
License Number: 20698 Primary Status: Current - Active
Address :
16748 Golden Valley Parkway
LATHROP CA 95330
SAN JOAQUIN COUNTY
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: MY KIDS DENTIST DENTAL GROUP, LIN, PHAM AND NAKAKI DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 19141 Primary Status: Current - Active
Address :
2290 DANIELS STREET
MANTECA CA 95337
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: STADIUM DENTAL GROUP, LIN, PHAM AND NAKAKI DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 19109 Primary Status: Current - Active
Address :
2288 DANIELS STREET
MANTECA CA 95337
SAN JOAQUIN COUNTY
