Dental Board of California
Licensing details for: 17290
Name: SAN ELIJO PEDIATRIC DENTAL PRACTICE & ORTHODONTICS DR. MAUSETH
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: SAN ELIJO PEDIATRIC DENTISTRY & ORTHODONTICS DR. MAUSETH
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MAUSETH, SPENCER EUGENE
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: MAUSETH, SPENCER EUGENE
License/Registration Type: Dentist License
License Number: 61986 Primary Status: Current - Active
Address :
16918 Dove Canyon Rd
#203
SAN DIEGO CA 92127-3445
SAN DIEGO COUNTY
