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Licensing details for: 10797

Name: CARMEL VALLEY PEDIATRIC DENTISTRY, DENTAL PRACTICE OF CHIEU PHAM

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

12395 EL CAMINO REAL #218
SAN DIEGO CA 92130
SAN DIEGO county
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Practice Location

12395 EL CAMINO REAL #218
SAN DIEGO CA 92130
SAN DIEGO county
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Issuance Date

September 27, 2013

Expiration Date

August 31, 2021

Current Date / Time

June 6, 2025
2:0:11 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: PHAM, CHIEU L

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: PHAM, CHIEU L

License/Registration Type: Dentist License

License Number: 52916 Primary Status: Current - Active

Address :
2015 Birch Rd Ste 103
CHULA VISTA CA 91915-2003
SAN DIEGO COUNTY

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