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Licensing details for: 13289

Name: ENCINITAS PEDIATRIC DENTISTRY DENTAL PRACTICE OF PHAM AND MAUSETH DDS INC

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

135 SAXONY ROAD, #200
ENCINITAS CA 92024
SAN DIEGO county
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Practice Location

135 SAXONY ROAD, #200
ENCINITAS CA 92024
SAN DIEGO county
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Issuance Date

January 24, 2017

Expiration Date

August 31, 2025

Current Date / Time

June 6, 2025
1:56:16 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: PHAM, CHIEU L

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: MAUSETH, SPENCER EUGENE

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: MAUSETH, SPENCER EUGENE

License/Registration Type: Dentist License

License Number: 61986 Primary Status: Current - Active

Address :
16918 Dove Canyon Rd
#203
SAN DIEGO CA 92127-3445
SAN DIEGO COUNTY

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