Dental Board of California
Licensing details for: 80377
Name: WALTER JEFFERSON DENTAL CORPORATION
License Type: Additional Office Permit
Primary Status: Current - Active
Organization Classification: Corporation
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: LE, VICTORIA NGUYEN
License/Registration Type: Dentist License
License Number: 59604 Primary Status: Current - Active
Address :
1905 Calle Barcelona
#206
CARLSBAD CA 92009-8450
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: JEFFERSON, WALTER
License/Registration Type: Dentist License
License Number: 53460 Primary Status: Current - Active
Address :
16475 SIERRA LAKES PKWY
STE 140
FONTANA CA 92336
SAN BERNARDINO COUNTY
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: NGUYEN, BACH XUAN
License/Registration Type: Dentist License
License Number: 49784 Primary Status: Current - Active
Address :
4443 Candlewood St
LAKEWOOD CA 90712-1736
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: OATES, CHRISTOPHER COLLINS
License/Registration Type: Dentist License
License Number: 58874 Primary Status: Current - Active
Address :
1559 Pacific Coast Hwy
Ste 101
HERMOSA BEACH CA 90254-3214
LOS ANGELES COUNTY
