Dental Board of California
Licensing details for: 16106
Name: MOSSDALE DENTAL OFFICE PRACTICE OF TATH FAMILY DENTAL, INC
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: TATH, PON TURTLE
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: TATH, PON TURTLE
License/Registration Type: Dentist License
License Number: 58706 Primary Status: Current - Active
Address :
220 Towne Centre Dr
LATHROP CA 95330-9382
SAN JOAQUIN COUNTY
