Dental Board of California
Licensing details for: 16481
Name: POWAY FAMILY DENTAL GROUP, JAISWAL AND DALTON 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: PHAM, MINH BAO
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ARIANNEJAD, BABAK
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: NOSTI, JOHN CHARLES
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DALTON, MICHAEL J
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JAISWAL, EKTA
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: ARIANNEJAD, BABAK
License/Registration Type: Dentist License
License Number: 59452 Primary Status: Current - Active
Address :
718 W Washington St
SAN DIEGO CA 92103-1938
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: JAISWAL, EKTA
License/Registration Type: Dentist License
License Number: 56722 Primary Status: Current - Active
Address :
13616 Poway Rd
Suite 100
POWAY CA 92064-6548
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: DALTON, MICHAEL J
License/Registration Type: Dentist License
License Number: 38826 Primary Status: Current - Active
Address :
15345 GARDEN RD
POWAY CA 92064
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: 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: NOSTI, JOHN CHARLES
License/Registration Type: Dentist License
License Number: 48655 Primary Status: Current - Active
Address :
709 Center Dr Ste 101
SAN MARCOS CA 92069-2502
SAN DIEGO COUNTY
