Dental Board of California
Licensing details for: 13896
Name: SANTEE PEDIATRIC DENTISTRY, DENTAL PRACTICE OF BPM DENTAL PARTNERSHIP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Partnership
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MAUSETH, SPENCER EUGENE
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BUZZELL, JORDAN NATHANIEL
Address Not Disclosed
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: 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
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
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: BUZZELL, JORDAN NATHANIEL
License/Registration Type: Dentist License
License Number: 57219 Primary Status: Current - Active
Address :
110 TOWN CENTER PARKWAY
Suite A
SANTEE CA 92071
SAN DIEGO COUNTY
