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Licensing details for: 12932

Name: DENTISTS OF SOUTH BAY DENTAL GROUP JOAN THANH TO DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

5023 PACIFIC COAST HIGHWAY
TORRANCE CA 90505
LOS ANGELES county
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Practice Location

5023 PACIFIC COAST HIGHWAY
TORRANCE CA 90505
LOS ANGELES county
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Issuance Date

June 21, 2016

Expiration Date

June 30, 2025

Current Date / Time

June 6, 2025
2:0:9 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: SHARIFIAN, ALEX R.

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: TO, JOAN THANH

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GHAZAL, CAROLYN G

Address Not Disclosed

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: SHARIFIAN, ALEX R.

License/Registration Type: Dentist License

License Number: 44540 Primary Status: Current - Active

Address :
13721 Newport Ave
Suite 1
TUSTIN CA 92780-4690
ORANGE COUNTY

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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

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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: GHAZAL, CAROLYN G

License/Registration Type: Dentist License

License Number: 38682 Primary Status: Current - Active

Address :
10797 FOOTHILL BLVD
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO COUNTY

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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: TO, JOAN THANH

License/Registration Type: Dentist License

License Number: 53880 Primary Status: Current - Active

Address :
5023 Pacific Coast Hwy
TORRANCE CA 90505-5441

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