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Licensing details for: 79890

Name: PHAM & MAUSETH, DDS, INC.

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

3820 CONVOY STREET
SAN DIEGO CA 92111
SAN DIEGO county
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Practice Location

3820 CONVOY STREET
SAN DIEGO CA 92111
SAN DIEGO county
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Issuance Date

November 20, 2018

Expiration Date

October 31, 2021

Current Date / Time

December 13, 2025
11:38:59 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: MAUSETH, SPENCER EUGENE

License/Registration Type: Dentist License

License Number: 61986 Primary Status: Current - Active

Address :
16918 Dove Canyon Rd
#203
SAN DIEGO CA 92127-3445
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: PHAM, CHIEU L

License/Registration Type: Dentist License

License Number: 52916 Primary Status: Current - Active

Address :
2015 Birch Rd Ste 103
CHULA VISTA CA 91915-2003
SAN DIEGO COUNTY

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