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Licensing details for: 14310

Name: SONRISA DENTAL, DENTAL PRACTICE OF PHAM AND MAUSETH DDS INC.

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

510 BROADWAY UNIT 4
CHULA VISTA CA 91910
SAN DIEGO county
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Practice Location

510 BROADWAY UNIT 4
CHULA VISTA CA 91910
SAN DIEGO county
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Issuance Date

July 11, 2018

Expiration Date

October 31, 2021

Current Date / Time

June 7, 2025
4:5:9 AM

License Relationships

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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