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Licensing details for: 9107

Name: HEALTHY SMILE DENTISTRY, DENTAL OFFICE OF ANDREW T. NGUYEN DMD IN

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Previous Names: HEALTHY SMILE DENTISTRY

Address of Record

30141 ANTELOPE ROAD
STE. G
MENIFEE CA 92584
RIVERSIDE county
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Practice Location

30141 ANTELOPE ROAD
STE. G
MENIFEE CA 92584
RIVERSIDE county
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Issuance Date

December 15, 2010

Expiration Date

May 31, 2019

Current Date / Time

June 7, 2025
9:27:8 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: PHUNG, CHRISTINE THU

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: PHUNG, CHRISTINE THU

License/Registration Type: Dentist License

License Number: 46931 Primary Status: Current - Active

Address :
4902 Irvine Center Dr Ste 1
IRVINE CA 92604-3305
ORANGE COUNTY

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