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Licensing details for: 9891

Name: BEACH CITY DENTAL GROUP, JOAN TO DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Previous Names: BEACH CITY DENTAL GROUP

Address of Record

1509 HAWTHORNE BOULEVARD, STE. 102
REDONDO BEACH CA 90278
LOS ANGELES county
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Practice Location

1509 HAWTHORNE BOULEVARD, STE. 102
REDONDO BEACH CA 90278
LOS ANGELES county
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Issuance Date

April 19, 2012

Expiration Date

June 30, 2017

Current Date / Time

June 6, 2025
1:23:43 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: REAGAN, DARIN SCOTT

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

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