Dental Board of California
Licensing details for: 15140
Name: KENSINGTON DENTAL GROUP, LE AND PHAM 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: REAGAN, DARIN SCOTT
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LE, RONNY TRAN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WATANABE, LYNDA CAROL
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PHAM, MINH BAO
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, LYNDA CAROL
License/Registration Type: Dentist License
License Number: 40116 Primary Status: Current - Active
Address :
8715 Trautwein Rd
RIVERSIDE CA 92508-9474
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: 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
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: PHAM, MINH BAO
License/Registration Type: Dentist License
License Number: 46321 Primary Status: Expired
Address :
5675 Balboa Ave
SAN DIEGO CA 92111-2705
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: LE, RONNY TRAN
License/Registration Type: Dentist License
License Number: 62766 Primary Status: Current - Active
Address :
4142 Adams Ave
Suite 104
SAN DIEGO CA 92116-2592
SAN DIEGO COUNTY
