Dental Board of California
Licensing details for: 16924
Name: LOS OLIVOS DENTISTRY DENTAL GROUP, KEVIN SU DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: Kevin Su Dental Corporation
License Relationships
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: SHETTY, SWATI
License/Registration Type: Dentist License
License Number: 50587 Primary Status: Current - Active
Address :
17160 Colima Rd Ste C
HACIENDA HEIGHTS CA 91745-6785
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: PANDHOH, SUMEET SWAROOP
License/Registration Type: Dentist License
License Number: 51507 Primary Status: Current - Active
Address :
45 Auto Center Dr
Suite 110
FOOTHILL RANCH CA 92610-2848
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: NGUYEN, BACH XUAN
License/Registration Type: Dentist License
License Number: 49784 Primary Status: Current - Active
Address :
13528 Lakewood Blv
BELLFLOWER CA 90706
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: SU, KEVIN JING-YUAN
License/Registration Type: Dentist License
License Number: 103905 Primary Status: Current - Active
Address :
8561 Irvine Center Dr
IRVINE CA 92618-4298
ORANGE COUNTY
