Dental Board of California
Licensing details for: 13384
Name: DIAMOND VALLEY DENTIST A DENTAL OFFICE OF NATHAN JERGENSEN DMD INC.
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JERGENSEN, NATHAN ORME
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: JERGENSEN, NATHAN ORME
License/Registration Type: Dentist License
License Number: 63962 Primary Status: Current - Active
Address :
43980 Margarita Rd
#101
TEMECULA CA 92592-2782
RIVERSIDE COUNTY
