Dental Board of California
Licensing details for: 16582
Name: BRENTWOOD MODERN DENTISTRY DENTAL GROUP, MCDONOUGH 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: CHOKKA, SUDHAKAR RAO
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: JEFFERSON, WALTER
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MCDONOUGH, SHAELAN DAVID
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: HUYNH, PHI CANH
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: HUYNH, PHI CANH
License/Registration Type: Dentist License
License Number: 56413 Primary Status: Current - Active
Address :
11700 Heliotrope Ct
BAKERSFIELD CA 93311-8751
KERN 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: MCDONOUGH, SHAELAN DAVID
License/Registration Type: Dentist License
License Number: 56210 Primary Status: Current - Active
Address :
12013 Wilshire Blvd
LOS ANGELES CA 90025-1201
LOS ANGELES 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: 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
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: CHOKKA, SUDHAKAR RAO
License/Registration Type: Dentist License
License Number: 41376 Primary Status: Current - Active
Address :
27949 Greenspot Rd
Ste. H
HIGHLAND CA 92346-4443
SAN BERNARDINO 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: 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
