Dental Board of California
Licensing details for: 14069
Name: COLLEGE GROVE DENTISTRY DENTAL GROUP, HEJAZI DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: HEJAZI, ALI
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: REAGAN, DARIN SCOTT
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: NOSTI, JOHN CHARLES
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WATANABE, BRYAN KAZUMI
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: WATANABE, BRYAN KAZUMI
License/Registration Type: Dentist License
License Number: 40130 Primary Status: Current - Active
Address :
40760 California Oaks Rd.
MURRIETA CA 92562
RIVERSIDE 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: HEJAZI, ALI
License/Registration Type: Dentist License
License Number: 64850 Primary Status: Current - Active
Address :
3408 College Ave
SAN DIEGO CA 92115
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: NOSTI, JOHN CHARLES
License/Registration Type: Dentist License
License Number: 48655 Primary Status: Current - Active
Address :
709 Center Dr Ste 101
SAN MARCOS CA 92069-2502
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: 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
