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Licensing details for: 80884

Name: JAISWAL AND DALTON DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

13616 POWAY ROAD SUITE 100
POWAY CA 92064
SAN DIEGO county
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Practice Location

13616 POWAY ROAD SUITE 100
POWAY CA 92064
SAN DIEGO county
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Issuance Date

April 20, 2021

Expiration Date

December 31, 2025

Current Date / Time

June 6, 2025
2:25:17 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: DALTON, MICHAEL J

License/Registration Type: Dentist License

License Number: 38826 Primary Status: Current - Active

Address :
15345 GARDEN RD
POWAY CA 92064
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: ARIANNEJAD, BABAK

License/Registration Type: Dentist License

License Number: 59452 Primary Status: Current - Active

Address :
718 W Washington St
SAN DIEGO CA 92103-1938
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: JAISWAL, EKTA

License/Registration Type: Dentist License

License Number: 56722 Primary Status: Current - Active

Address :
13616 Poway Rd
Suite 100
POWAY CA 92064-6548
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: 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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