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Licensing details for: 58713

Name: TON, CONG THAT

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Address of Record

9631 RINDGE CIRCLE
FOUNTAIN VALLEY CA 92708
ORANGE county
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Issuance Date

August 13, 2009

Expiration Date

April 30, 2027

Current Date / Time

June 6, 2025
2:44:58 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: TON AND DHAMA DENTAL CORPORATION

License/Registration Type: Additional Office Permit

License Number: 80178 Primary Status: Current - Active

Address :
6445 PAT'S RANCH ROAD, SUITE G
MIRA LOMA CA 91752
RIVERSIDE COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: MIRA LOMA SMILES DENTISTRY DENTAL GROUP TON AND DHAMA DENTAL CORPORATION

License/Registration Type: Fictitious Name Permit

License Number: 15155 Primary Status: Current - Active

Address :
6445 PAT'S RANCH ROAD, SUITE G
MIRA LOMA CA 91752
RIVERSIDE COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: MIRA LOMA SMILES DENTISTRY, DENTAL GROUP OF TON AND DHAMA DENTAL

License/Registration Type: Fictitious Name Permit

License Number: 10873 Primary Status: Cancelled

Address :
6445 PAT'S RANCH ROAD SUITE G
MIRA LOMA CA 91752
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: MIRA LOMA SMILES DENTISTRY, DENTAL GROUP OF TON AND DHAMA DENTAL

License/Registration Type: Fictitious Name Permit

License Number: 10873 Primary Status: Cancelled

Address :
6445 PAT'S RANCH ROAD SUITE G
MIRA LOMA CA 91752
RIVERSIDE COUNTY

Map

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: MIRA LOMA SMILES DENTISTRY DENTAL GROUP TON AND DHAMA DENTAL CORPORATION

License/Registration Type: Fictitious Name Permit

License Number: 15155 Primary Status: Current - Active

Address :
6445 PAT'S RANCH ROAD, SUITE G
MIRA LOMA CA 91752
RIVERSIDE COUNTY

Map

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