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Licensing details for: 79132

Name: QUAN THIEN MA DDS

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Sole Owner

Address of Record

315 Walnut Ave
SAN DIEGO CA 92103-4904
SAN DIEGO county
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Practice Location

315 Walnut Ave
SAN DIEGO CA 92103-4904
SAN DIEGO county
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Issuance Date

October 26, 2016

Expiration Date

February 29, 2028

Current Date / Time

November 9, 2026
5:15:16 PM

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: MA, QUAN T

License/Registration Type: Dentist License

License Number: 62908 Primary Status: Current - Active

Address :
6650 Flanders Dr Ste J
SAN DIEGO CA 92121-3908
SAN DIEGO COUNTY

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