Dental Board of California
Licensing details for: 14412
Name: 17TH STREET MODERN DENTISTRY DENTAL GROUP CLINT WALKER DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
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: NGUYEN, BACH XUAN
License/Registration Type: Dentist License
License Number: 49784 Primary Status: Current - Active
Address :
13528 Lakewood Blv
BELLFLOWER CA 90706
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: SHETTY, SWATI
License/Registration Type: Dentist License
License Number: 50587 Primary Status: Current - Active
Address :
17160 Colima Rd Ste C-1
HACIENDA HEIGHTS CA 91745-6785
LOS ANGELES 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 :
30592 Santa Margarita Prkwy
Ste. D
RANCHO SANTA MARGARI CA 92688
ORANGE 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: WALKER, CLINT CODY
License/Registration Type: Dentist License
License Number: 63663 Primary Status: Current - Active
Address :
270 E 17th St
Ste 15
COSTA MESA CA 92627-3861
ORANGE 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: NAJAFI, NEUSHA
License/Registration Type: Dentist License
License Number: 57792 Primary Status: Current - Active
Address :
8502 E Chapman Ave
#381
ORANGE CA 92869-2461
ORANGE COUNTY
