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Licensing details for: 18429

Name: ORANGE COUNTY CENTERS FOR ORAL SURGERY AND DENTAL IMPLANTS BY ELDER DENTAL GROUP

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

1171 PUERTA DEL SOL., SUITE D
SAN CLEMENTE CA 92673
ORANGE county
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Practice Location

1171 PUERTA DEL SOL., SUITE D
SAN CLEMENTE CA 92673
ORANGE county
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Issuance Date

March 4, 2024

Expiration Date

January 31, 2025

Current Date / Time

June 6, 2025
2:10:54 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ELDER, MAHR F

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: ELDER, MAHR F

License/Registration Type: Dentist License

License Number: 46586 Primary Status: Current - Active

Address :
1805 Novato Blvd
Suite 1
NOVATO CA 94947-2934
MARIN COUNTY

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