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Licensing details for: 280

Name: TAN, MINTRA

License Type: Pediatric Minimal Sedation Permit

Primary Status: Current - Active

Address of Record

151 S MEDNIK AVE.
LOS ANGELES CA 90022
LOS ANGELES county
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Practice Location

151 S MEDNIK AVE.
LOS ANGELES CA 90022
LOS ANGELES county
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Issuance Date

May 17, 2024

Expiration Date

January 31, 2026

Current Date / Time

June 6, 2025
2:2:7 AM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CHILDREN'S DENTAL PLANET, DENTAL GROUP OF TAN, DDS AND TRAN, DDS,

License/Registration Type: Fictitious Name Permit

License Number: 10523 Primary Status: Current - Active

Address :
151 S. MEDNIK AVENUE
LOS ANGELES CA 90022
LOS ANGELES COUNTY

Map

PMS to DDS or OMS or SP

License/Registration Role: Pediatric Minimal Sedation Permit

Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit

Name: TAN, MINTRA

License/Registration Type: Dentist License

License Number: 53108 Primary Status: Current - Active

Address Not Disclosed

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