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Licensing details for: 14933

Name: SAN DIEGO CHILDREN'S DENTISTRY DENTAL GROUP OF NATHAN CHRISTENSEN, DDS

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Partnership

Address of Record

12324 OAK KNOLL RD
POWAY CA 92064
SAN DIEGO county
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Practice Location

12324 OAK KNOLL RD
POWAY CA 92064
SAN DIEGO county
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Issuance Date

April 8, 2019

Expiration Date

July 31, 2022

Current Date / Time

June 6, 2025
1:34:4 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: HENRIOD, JOEL B

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: CHRISTENSEN, NATHAN FJELDSTED

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: CHRISTENSEN, NATHAN FJELDSTED

License/Registration Type: Dentist License

License Number: 61358 Primary Status: Current - Active

Address :
10652 El Caballo Ave
SAN DIEGO CA 92127-3310
SAN DIEGO COUNTY

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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: HENRIOD, JOEL B

License/Registration Type: Dentist License

License Number: 55124 Primary Status: Current - Active

Address :
72 N Hill Ave
PASADENA CA 91106-1905
LOS ANGELES COUNTY

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