Dental Board of California
Licensing details for: 3726
Name: TIERRASANTA FAMILY DENTAL GROUP OF MANJI AND
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
10715 TIERRASANTA BLVD
SAN DIEGO CA 92124
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MANJI, MEHMOOD FATEHALI
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MENDIVIL, GUY WILLIAM
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: MENDIVIL, GUY WILLIAM
License/Registration Type: Dentist License
License Number: 29737 Primary Status: Current - Active
Address :
11901 Bolthouse Dr
SUITE 200
BAKERSFIELD CA 93311-8455
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: MANJI, MEHMOOD FATEHALI
License/Registration Type: Dentist License
License Number: 46109 Primary Status: Current - Active
Address :
467 College Blvd
Suite 2
OCEANSIDE CA 92057-5436
