Dental Board of California
Licensing details for: 17046
Name: CHANNEL ISLANDS ORAL & MAXILLOFACIAL SURGERY JESSE LANZON, DDS, MD, REYNALDO RIVERA, DDS, MD, FACS DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Partnership
Previous Names: CHANNEL ISLANDS ORAL & MAXILLOFACIAL SURGERY JESSE LANZON, DDS, MD, REYNALDO RIVERA, DDS, MD, FACS
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RIVERA, REYNALDO DAVID
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LANZON, JESSE LAWRENCE
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: LANZON, JESSE LAWRENCE
License/Registration Type: Dentist License
License Number: 56306 Primary Status: Current - Active
Address :
1111 E Ocean Ave Ste 9
LOMPOC CA 93436-2501
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: RIVERA, REYNALDO DAVID
License/Registration Type: Dentist License
License Number: 106044 Primary Status: Current - Active
Address :
67 S Glenn Dr
67 S Glenn Dr
CAMARILLO CA 93010-7944
