Dental Board of California
Licensing details for: 53108
Name: TAN, MINTRA
License Type: Dentist
Primary Status: Current - Active
Address not disclosed
License Relationships
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: TAN, MINTRA
License/Registration Type: Conscious Sedation Permit
License Number: 496 Primary Status: Cancelled
Address Not Disclosed
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CHILDREN'S DENTAL PLANET, DENTAL GROUP OF TAN, DDS AND TRAN, DDS,
License/Registration Type: Fictitious Name Permit
License Number: 10523 Primary Status: Current - Active
Address :
151 S. MEDNIK AVENUE
LOS ANGELES CA 90022
LOS ANGELES 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: CHILDREN'S DENTAL PLANET, DENTAL GROUP OF TAN, DDS AND TRAN, DDS,
License/Registration Type: Fictitious Name Permit
License Number: 10523 Primary Status: Current - Active
Address :
151 S. MEDNIK AVENUE
LOS ANGELES CA 90022
LOS ANGELES COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: TAN, MINTRA
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 1788 Primary Status: Cancelled
Address :
151 S Mednik Ave
LOS ANGELES CA 90022-1606
LOS ANGELES COUNTY
PMS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Pediatric Minimal Sedation Permit
Name: TAN, MINTRA
License/Registration Type: Pediatric Minimal Sedation Permit
License Number: 280 Primary Status: Current - Active
Address :
151 S MEDNIK AVE.
LOS ANGELES CA 90022
LOS ANGELES COUNTY
