Dental Board of California
Licensing details for: 40351
Name: FONG, CLARK LEONG
License Type: Dentist
Primary Status: Current - Active
Address of Record
401A N San Mateo Dr
SAN MATEO CA 94401-2417
SAN MATEO county
Map
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: DR. CLARK L. FONG, DDS, A PROFESSIONAL DENTAL CORP
License/Registration Type: Additional Office Permit
License Number: 11071 Primary Status: Cancelled
Address :
1523 5TH AVENUE
SAN RAFAEL CA 94901
MARIN COUNTY
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: DR. CLARK L. FONG, DDS, A PROFESSIONAL DENTAL CORP
License/Registration Type: Additional Office Permit
License Number: 11007 Primary Status: Current - Active
Address :
155 BIRCH STREET, #5
REDWOOD CITY CA 94062
SAN MATEO COUNTY
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: DR. CLARK L. FONG, DDS, A PROFESSIONAL DENTAL CORP
License/Registration Type: Additional Office Permit
License Number: 11038 Primary Status: Current - Active
Address :
1523 5TH AVENUE
SAN RAFAEL CA 94901
MARIN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: BIRCH DENTAL GROUP, CLARK L. FONG, DDS, A PROF. CORP.
License/Registration Type: Fictitious Name Permit
License Number: 8744 Primary Status: Current - Active
Address :
155 BIRCH STREET
STE. 5
REDWOOD CITY CA 94062
SAN MATEO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: BIRCH DENTAL GROUP, NORMAN YUNG, DMD & CLARK L. FONG, DDS, A PROF
License/Registration Type: Fictitious Name Permit
License Number: 7233 Primary Status: Cancelled
Address :
155 BIRCH STREET
STE. 5
REDWOOD CITY CA 94067
SAN MATEO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: VAN NESS DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1040 Primary Status: Expired
Address :
CHARLES NIP DDS, INC.
2243 VAN NESS AVE STE 101
SAN FRANCISCO CA 94109
SAN FRANCISCO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PACIFIC DENTAL GROUP, CLARK L. FONG, DDS, A PROFESSIONAL DENTAL C
License/Registration Type: Fictitious Name Permit
License Number: 10219 Primary Status: Current - Active
Address :
1523 5TH AVENUE
SAN RAFAEL CA 94901
MARIN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: SOUTH VAN NESS DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1041 Primary Status: Expired
Address :
CHARLES NIP DDS
240 SHOTWELL ST STE 230
SAN FRANCISCO CA 94110
SAN FRANCISCO 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: VAN NESS DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1040 Primary Status: Expired
Address :
CHARLES NIP DDS, INC.
2243 VAN NESS AVE STE 101
SAN FRANCISCO CA 94109
SAN FRANCISCO 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: BIRCH DENTAL GROUP, NORMAN YUNG, DMD & CLARK L. FONG, DDS, A PROF
License/Registration Type: Fictitious Name Permit
License Number: 7233 Primary Status: Cancelled
Address :
155 BIRCH STREET
STE. 5
REDWOOD CITY CA 94067
SAN MATEO 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: SOUTH VAN NESS DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1041 Primary Status: Expired
Address :
CHARLES NIP DDS
240 SHOTWELL ST STE 230
SAN FRANCISCO CA 94110
SAN FRANCISCO 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: BIRCH DENTAL GROUP, CLARK L. FONG, DDS, A PROF. CORP.
License/Registration Type: Fictitious Name Permit
License Number: 8744 Primary Status: Current - Active
Address :
155 BIRCH STREET
STE. 5
REDWOOD CITY CA 94062
SAN MATEO 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: PACIFIC DENTAL GROUP, CLARK L. FONG, DDS, A PROFESSIONAL DENTAL C
License/Registration Type: Fictitious Name Permit
License Number: 10219 Primary Status: Current - Active
Address :
1523 5TH AVENUE
SAN RAFAEL CA 94901
MARIN COUNTY
