Dental Board of California
Licensing details for: 59169
Name: ANTONIO, JASON CLAY
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: JASON ANTONIO DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81182 Primary Status: Current - Active
Address :
28080 CLINTON KEITH ROAD, SUITE 100
MURRIETA CA 92563
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MURRIETA MODERN DENTISTRY DENTALGROUP, JASON ANTONIO DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17110 Primary Status: Current - Active
Address :
28080 CLINTON KEITH ROAD, SUITE 100
MURRIETA CA 92563
RIVERSIDE 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: MURRIETA MODERN DENTISTRY DENTALGROUP, JASON ANTONIO DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17110 Primary Status: Current - Active
Address :
28080 CLINTON KEITH ROAD, SUITE 100
MURRIETA CA 92563
RIVERSIDE 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: ANTONIO, JASON CLAY
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 4273 Primary Status: Current - Active
Address :
28080 Clinton Keith Rd
STE 100
MURRIETA CA 92563-4552
RIVERSIDE COUNTY
