Dental Board of California
Licensing details for: 13808
Name: BRIGHTON DENTAL CLINIQUE, DRS RAVON AND BASHAWATY DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Partnership
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BASHAWATY, WALLY
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: BASHAWATY, WALLY
License/Registration Type: Dentist License
License Number: 45429 Primary Status: Current - Active
Address :
1501 Superior Ave
Suite 306
NEWPORT BEACH CA 92663-3600
ORANGE COUNTY
