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Licensing details for: 80199

Name: LAU AND PARK DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

415 SANTA FE DRIVE
ENCINITAS CA 92024
SAN DIEGO county
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Practice Location

415 SANTA FE DRIVE
ENCINITAS CA 92024
SAN DIEGO county
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Issuance Date

July 17, 2019

Expiration Date

December 31, 2026

Current Date / Time

June 6, 2025
2:32:1 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: LAU, KENT

License/Registration Type: Dentist License

License Number: 63511 Primary Status: Current - Active

Address :
415 Santa Fe Dr
Encinitas Smiles Dentistry
ENCINITAS CA 92024-5134
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, 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: NOSTI, JOHN CHARLES

License/Registration Type: Dentist License

License Number: 48655 Primary Status: Current - Active

Address :
709 Center Dr Ste 101
SAN MARCOS CA 92069-2502
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: PARK, CLINTON H

License/Registration Type: Dentist License

License Number: 48531 Primary Status: Current - Active

Address :
1340 ENCINITAS BLVD
SUITE 100
ENCINITAS CA 92024
SAN DIEGO COUNTY

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