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Licensing details for: 79087

Name: DO-YABUT AND PHAM DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

435 4th Ave
SAN DIEGO CA 92101-6234
SAN DIEGO county
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Practice Location

435 4th Ave
SAN DIEGO CA 92101-6234
SAN DIEGO county
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Issuance Date

September 7, 2016

Expiration Date

December 31, 2019

Current Date / Time

June 6, 2025
2:16:21 AM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: DO YABUT, DIANA SONG

License/Registration Type: Dentist License

License Number: 53903 Primary Status: Current - Active

Address :
20201 CHIANTI COURT
YORBA LINDA CA 92886
ORANGE COUNTY

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AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: PHAM, MINH BAO

License/Registration Type: Dentist License

License Number: 46321 Primary Status: Expired

Address :
5675 Balboa Ave
SAN DIEGO CA 92111-2705
SAN DIEGO COUNTY

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AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: REAGAN, DARIN SCOTT

License/Registration Type: Dentist License

License Number: 34407 Primary Status: Current - Active

Address :
943 AVENIDA PICO, STE. A
SAN CLEMENTE CA 92673
ORANGE COUNTY

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AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: RYGG, LANCE CHRISTIAN

License/Registration Type: Dentist License

License Number: 30251 Primary Status: Cancelled

Address :
9862 E MISSION GORGE RD, STE E
SANTEE CA 92071
SAN DIEGO COUNTY

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AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: WATANABE, LYNDA CAROL

License/Registration Type: Dentist License

License Number: 40116 Primary Status: Current - Active

Address :
8715 Trautwein Rd
RIVERSIDE CA 92508-9474
RIVERSIDE COUNTY

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