Dental Board of California
Licensing details for: 63962
Name: JERGENSEN, NATHAN ORME
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Previous Names: JERGENSEN, NATHAN O
Address of Record
43980 Margarita Rd
#101
TEMECULA CA 92592-2782
RIVERSIDE county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: DIAMOND VALLEY DENTIST A DENTAL OFFICE OF NATHAN JERGENSEN DMD INC.
License/Registration Type: Fictitious Name Permit
License Number: 13384 Primary Status: Expired
Address :
1031 E LATHAM AVE STE 2
HEMET CA 92543
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: DIAMOND VALLEY DENTIST A DENTAL OFFICE OF NATHAN JERGENSEN DMD INC.
License/Registration Type: Fictitious Name Permit
License Number: 13384 Primary Status: Expired
Address :
1031 E LATHAM AVE STE 2
HEMET CA 92543
RIVERSIDE COUNTY
