Dental Board of California
Licensing details for: 15099
Name: CLINTON KEITH DENTAL GROUP DIANA DO-YABUT AND BRYAN WATANABE DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SANDERS, TYLER MICHAEL
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: SANDERS, TYLER MICHAEL
License/Registration Type: Dentist License
License Number: 102821 Primary Status: Expired
Address :
6965 EL CAMINO REAL 105-645
CARLSBAD CA 92009
SAN DIEGO COUNTY
