Dental Board of California
Licensing details for: 58706
Name: TATH, PON TURTLE
License Type: Dentist
Primary Status: Current - Active
Secondary Status: Licensure by Residency
Previous Names: TATH, PHAN TURTLE
Address of Record
220 Towne Centre Dr
LATHROP CA 95330-9382
SAN JOAQUIN county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MOSSDALE DENTAL OFFICE PRACTICE OF TATH FAMILY DENTAL, INC
License/Registration Type: Fictitious Name Permit
License Number: 16106 Primary Status: Current - Active
Address :
220 TOWNE CENTRE DR
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: MOSSDALE DENTAL OFFICE PRACTICE OF TATH FAMILY DENTAL, INC
License/Registration Type: Fictitious Name Permit
License Number: 16106 Primary Status: Current - Active
Address :
220 TOWNE CENTRE DR
LATHROP CA 95330
SAN JOAQUIN COUNTY
