Dental Board of California
Licensing details for: 100873
Name: PARK, ETHAN SANG BAE
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
3860 2nd Ave
LA CRESCENTA CA 91214-2315
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CAMELLIA DENTISTRY, DENTAL PRACTICE OF ETHAN PARK, DMD, INC.
License/Registration Type: Fictitious Name Permit
License Number: 16855 Primary Status: Expired
Address :
5728 ROSEMEAD BLVD
TEMPLE CITY CA 91780
LOS ANGELES COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: CAMELLIA DENTISTRY, DENTAL PRACTICE OF ETHAN PARK, DMD, INC.
License/Registration Type: Fictitious Name Permit
License Number: 16855 Primary Status: Expired
Address :
5728 ROSEMEAD BLVD
TEMPLE CITY CA 91780
LOS ANGELES COUNTY
