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Licensing details for: 414

Name: STEWART, RAY EDWARD

License Type: Pediatric Minimal Sedation Permit

Primary Status: Current - Active

Previous Names: STEWART, RAY E

Address of Record

189 Summit Way
SAN FRANCISCO CA 94132-2949
SAN FRANCISCO county
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Practice Location

La Clinica Dental at Children'
s Hospital
4881 Telegraph Avenue
OAKLAND CA 94609
ALAMEDA county
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Issuance Date

May 20, 2025

Expiration Date

November 30, 2026

Current Date / Time

June 7, 2025
4:31:45 AM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTRAL COAST PEDIATRIC DENTAL GROUP, DR'S

License/Registration Type: Fictitious Name Permit

License Number: 4573 Primary Status: Cancelled

Address :
1117 LOS PALOS DR
SALINAS CA 93901
MONTEREY COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTRAL COAST PEDIATRIC DENTAL GROUP, DR'S.

License/Registration Type: Fictitious Name Permit

License Number: 5565 Primary Status: Cancelled

Address :
633 E ALVIN DR, STE B
SALINAS CA 93906
MONTEREY COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTRAL COAST PEDIATRIC DENTAL GROUP, DR'S

License/Registration Type: Fictitious Name Permit

License Number: 4579 Primary Status: Cancelled

Address :
633 E ALVIN DR, STE B
SALINAS CA 93906
MONTEREY COUNTY

Map

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTRAL COAST PEDIATRIC DENTAL GROUP, DR'S.

License/Registration Type: Fictitious Name Permit

License Number: 5563 Primary Status: Cancelled

Address :
945 BLANCO CIRCLE, STE D
SALINAS CA 93901
MONTEREY COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTRAL COAST PEDIATRIC DENTAL GROUP, DR'S SANGER, STEWART,

License/Registration Type: Fictitious Name Permit

License Number: 4869 Primary Status: Cancelled

Address :
945 BLANCO CIRCLE, STE D
SALINAS CA 93901
MONTEREY COUNTY

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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: STEWART, RAY EDWARD

License/Registration Type: Dentist License

License Number: 31535 Primary Status: Current - Active

Address :
1840 3RD STREET
SAN FRANCISCO CA 94143
SAN FRANCISCO COUNTY

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