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Licensing details for: 15682

Name: THE DENTAL OFFICE OF CARSON WALTER JEFFERSON, D.D.S., INC.

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

612 E. CARSON STREET., SUITE 101
CARSON CA 90745
LOS ANGELES county
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Practice Location

612 E. CARSON STREET., SUITE 101
CARSON CA 90745
LOS ANGELES county
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Issuance Date

February 12, 2020

Expiration Date

July 31, 2025

Current Date / Time

June 6, 2025
2:10:50 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: JEFFERSON, WALTER

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: OATES, CHRISTOPHER COLLINS

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: CHON, DAVID JIMIN

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ELIE, ARASH

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: NGUYEN, BACH XUAN

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: NGUYEN, BACH XUAN

License/Registration Type: Dentist License

License Number: 49784 Primary Status: Current - Active

Address :
4443 Candlewood St
LAKEWOOD CA 90712-1736

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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: OATES, CHRISTOPHER COLLINS

License/Registration Type: Dentist License

License Number: 58874 Primary Status: Current - Active

Address :
1559 Pacific Coast Hwy
Ste 101
HERMOSA BEACH CA 90254-3214
LOS ANGELES 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: CHON, DAVID JIMIN

License/Registration Type: Dentist License

License Number: 65220 Primary Status: Current - Active

Address :
612 E Carson St Ste 101
CARSON CA 90745-2896
LOS ANGELES 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: ELIE, ARASH

License/Registration Type: Dentist License

License Number: 47470 Primary Status: Current - Active

Address :
15740 GREENLEAF STREET
ENCINO CA 91436
LOS ANGELES 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: JEFFERSON, WALTER

License/Registration Type: Dentist License

License Number: 53460 Primary Status: Current - Active

Address :
16475 SIERRA LAKES PKWY
STE 140
FONTANA CA 92336
SAN BERNARDINO COUNTY

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