Dental Board of California
Licensing details for: 4967
Name: SAN MARCOS DENTAL GROUP, REAGAN AND TIEU DENTAL CORPORTION
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
709 CENTER DR, STE 101
SAN MARCOS CA 92069
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: REAGAN, DARIN SCOTT
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TIEU, ANDY LIANG
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: REAGAN, DARIN SCOTT
License/Registration Type: Dentist License
License Number: 34407 Primary Status: Current - Active
Address :
943 AVENIDA PICO, STE. A
SAN CLEMENTE CA 92673
ORANGE 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: TIEU, ANDY LIANG
License/Registration Type: Dentist License
License Number: 49228 Primary Status: Current - Active
Address :
6790 TOP GUN ST. SUITE #5
SAN DIEGO CA 92121
SAN DIEGO COUNTY
