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Licensing details for: 9788

Name: CLINTON KEITH DENTAL GROUP, DIANA DO-YABUT AND BRYAN WATANABE DEN

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

23905 CLINTON KEITH ROAD, STE. 108
WILDOMAR CA 92595
RIVERSIDE county
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Practice Location

23905 CLINTON KEITH ROAD, STE. 108
WILDOMAR CA 92595
RIVERSIDE county
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Issuance Date

February 14, 2012

Expiration Date

December 31, 2019

Current Date / Time

June 7, 2025
8:17:40 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: RYGG, LANCE CHRISTIAN

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: RYGG, LANCE CHRISTIAN

License/Registration Type: Dentist License

License Number: 30251 Primary Status: Cancelled

Address :
9862 E MISSION GORGE RD, STE E
SANTEE CA 92071
SAN DIEGO COUNTY

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