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Licensing details for: 17946

Name: LA MESA MODERN DENTAL GROUP,, ARIANNEJAB AND PHAM DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

5620 LAKE MURRAY BLVD
LA MESA CA 91942
SAN DIEGO county
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Practice Location

5620 LAKE MURRAY BLVD
LA MESA CA 91942
SAN DIEGO county
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Issuance Date

July 7, 2023

Expiration Date

February 28, 2027

Current Date / Time

June 6, 2025
1:23:26 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ALVARADO, STEVEN CHRISTOPHER

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ARIANNEJAD, SHAHAB

Address Not Disclosed

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: NOSTI, JOHN CHARLES

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: 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

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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

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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, SHAHAB

License/Registration Type: Dentist License

License Number: 59609 Primary Status: Current - Active

Address :
5620 Lake Murray Blvd.
LA MESA CA 91942
SAN DIEGO COUNTY

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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: ALVARADO, STEVEN Christopher

License/Registration Type: Dentist License

License Number: 59267 Primary Status: Current - Active

Address :
4640 Cass St Unit 9720
SAN DIEGO CA 92109-2804
SAN DIEGO COUNTY

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