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Licensing details for: 9475

Name: PENDLETON FAMILY DENTAL GROUP, KAW DENTAL INC.

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Previous Names: PENDLETON FAMILY DENTAL GROUP

Address of Record

555020 BLDG #20845, STE. 109
MARINE CORPS BASE
CAMP PENDLETON CA 92055
SAN DIEGO county
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Practice Location

555020 BLDG #20845, STE. 109
MARINE CORPS BASE
CAMP PENDLETON CA 92055
SAN DIEGO county
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Issuance Date

August 9, 2011

Expiration Date

January 31, 2024

Current Date / Time

June 6, 2025
2:14:28 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: KAW, PHILLIP ZAW-HTUN

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: KAW, PHILLIP ZAW-HTUN

License/Registration Type: Dentist License

License Number: 40627 Primary Status: Current - Active

Address :
635 E Garvey Ave
MONTEREY PARK CA 91755-1910
LOS ANGELES COUNTY

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