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Licensing details for: 80895

Name: WATANABE AND LYNN PROFESSIONAL DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

18285 COLLIER AVENUE, SUITE B
LAKE ELSINORE CA 92530
RIVERSIDE county
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Practice Location

18285 COLLIER AVENUE, SUITE B
LAKE ELSINORE CA 92530
RIVERSIDE county
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Issuance Date

April 21, 2021

Expiration Date

July 31, 2026

Current Date / Time

June 6, 2025
2:13:21 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: DO YABUT, DIANA SONG

License/Registration Type: Dentist License

License Number: 53903 Primary Status: Current - Active

Address :
20201 CHIANTI COURT
YORBA LINDA CA 92886
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: WATANABE, BRYAN KAZUMI

License/Registration Type: Dentist License

License Number: 40130 Primary Status: Current - Active

Address :
40760 California Oaks Rd.
MURRIETA CA 92562
RIVERSIDE 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: LEE, FREDERICK HYUN WOO

License/Registration Type: Dentist License

License Number: 43359 Primary Status: Current - Active

Address :
4000 W. FLORIDA AVE.
HEMET CA 92545
RIVERSIDE 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: CHAU, KHANH NHAT

License/Registration Type: Dentist License

License Number: 64568 Primary Status: Current - Active

Address :
18285 COLLIER AVE STE B
LAKE ELSINORE CA 92530
RIVERSIDE 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: LYNN, STEVEN CHRISTOPHER

License/Registration Type: Dentist License

License Number: 48505 Primary Status: Current - Active

Address :
29273 Central Ave
Suite A
LAKE ELSINORE CA 92532
RIVERSIDE COUNTY

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