Dental Board of California
Licensing details for: 2564
Name: SOUTH COAST DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Partnership
Secondary Status: Cancelled at the Request of the Licensee
Address of Record
400 W. 24TH STREET, SUITE A
NATIONAL CITY CA 91950
SAN DIEGO county
Map
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: ESTRADA-GUEVARA, MARIA GUADALUPE
License/Registration Type: Dentist License
License Number: 36361 Primary Status: Current - Inactive
Address :
627 Wilmington Drive
CHULA VISTA CA 91914
SAN DIEGO 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: HERNANDEZ, CARMEN LETICIA
License/Registration Type: Dentist License
License Number: 38693 Primary Status: Current - Active
Address :
1635 THIRD AVENUE
SUITE D
CHULA VISTA CA 91911
SAN DIEGO 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: LARIN, LILIA
License/Registration Type: Dentist License
License Number: 37855 Primary Status: Current - Active
Address :
202 Mile Of Cars Way
NATIONAL CITY CA 91950-6605
SAN DIEGO COUNTY
