Dental Board of California
Licensing details for: 10219
Name: PACIFIC DENTAL GROUP, CLARK L. FONG, DDS, A PROFESSIONAL DENTAL C
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: PACIFIC DENTAL GROUP
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: FONG, CLARK LEONG
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: FONG, CLARK LEONG
License/Registration Type: Dentist License
License Number: 40351 Primary Status: Current - Active
Address :
401A N San Mateo Dr
SAN MATEO CA 94401-2417
SAN MATEO COUNTY
