Dental Board of California
Licensing details for: 10104
Name: EASTLAKE IMPLANT & TMJ DENTISTRY DENTAL PRACTICE, EDUARDO DIAZ DE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: EASTLAKE IMPLANT & TMJ DENTISTRY
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DIAZ, EDUARDO
Address Not Disclosed
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: DIAZ, EDUARDO
License/Registration Type: Dentist License
License Number: 44306 Primary Status: Current - Active
Address :
3638 Elcajon Blv
Siute A
SAN DIEGO CA 92104
SAN DIEGO COUNTY
