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Licensing details for: 6710

Name: OAKGROVE DENTAL GROUP, WATANABE AND LYNN PROF. DENTAL CORP.

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

18285 COLLIER AVE.
STE. B
LAKE ELSINORE CA 92530
RIVERSIDE county
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Issuance Date

February 5, 2007

Expiration Date

December 31, 2017

Current Date / Time

December 13, 2025
3:22:7 PM

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: WATANABE, BRYAN KAZUMI

License/Registration Type: Dentist License

License Number: 40130 Primary Status: Current - Active

Address :
40760 California Oaks Rd.
MURRIETA CA 92562
RIVERSIDE COUNTY

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