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Licensing details for: 1178

Name: NAM, DONGBIN

License Type: Oral Conscious Sedation

Primary Status: Cancelled

Specialty: Minor

Address of Record

257 S DE LACEY AVE
UNIT 2134
PASADENA CA 91105
LOS ANGELES county
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Issuance Date

April 9, 2007

Expiration Date

September 30, 2015

Current Date / Time

June 7, 2025
8:44:50 AM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: RADIX ENDODONTICS DENTAL GROUP OF KO AND NAM, DDS

License/Registration Type: Fictitious Name Permit

License Number: 17849 Primary Status: Current - Active

Address :
1317 W. FOOTHILL BLVD., STE 138
UPLAND CA 91786
SAN BERNARDINO COUNTY

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OCS to DDS, OMS, or SP

License/Registration Role: Oral Conscious Sedation Certificate

Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit

Name: NAM, DONGBIN

License/Registration Type: Dentist License

License Number: 49944 Primary Status: Current - Active

Address :
1317 W. Foothill Blvd.
Suite #138
UPLAND CA 91786
SAN BERNARDINO COUNTY

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