Dental Board of California
Licensing details for: 10325
Name: GATEWAY DENTAL GROUP, JACK GORMAN DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Secondary Status: Cancelled at the Request of the Licensee
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WATANABE, BRYAN KAZUMI
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: 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
