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Licensing details for: 80728

Name: SCOTT AND KANSAGRA DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

5685 ALTON PKWY.
IRVINE CA 92618
ORANGE county
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Practice Location

5685 ALTON PKWY.
IRVINE CA 92618
ORANGE county
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Issuance Date

December 1, 2020

Expiration Date

August 31, 2026

Current Date / Time

December 13, 2025
3:46:39 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: KANSAGRA, BINDU B

License/Registration Type: Dentist License

License Number: 57691 Primary Status: Current - Active

Address :
14415 Culver Dr
IRVINE CA 92604-0305
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: SHETTY, SWATI

License/Registration Type: Dentist License

License Number: 50587 Primary Status: Current - Active

Address :
17160 Colima Rd Ste C
HACIENDA HEIGHTS CA 91745-6785
LOS ANGELES 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: NGUYEN, BACH XUAN

License/Registration Type: Dentist License

License Number: 49784 Primary Status: Current - Active

Address :
13528 Lakewood Blv
BELLFLOWER CA 90706

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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: SCOTT, ERIC MICHAEL

License/Registration Type: Dentist License

License Number: 103114 Primary Status: Current - Active

Address :
5685 Alton Pkwy
IRVINE CA 92618-4059
ORANGE COUNTY

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