Dental Board of California
Licensing details for: 10393
Name: PCH SMILES DENTISTRY AND ORTHODONTICS, WALTER JEFFERSON DENTAL CO
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Secondary Status: Cancelled at the Request of the Licensee
Previous Names: PCH SMILES DENTISTRY AND ORTHODONTICS WALTER JEFFERSON DENTAL CORPORATION
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: REAGAN, DARIN SCOTT
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: REAGAN, DARIN SCOTT
License/Registration Type: Dentist License
License Number: 34407 Primary Status: Current - Active
Address :
943 AVENIDA PICO, STE. A
SAN CLEMENTE CA 92673
ORANGE COUNTY
