Dental Board of California
Licensing details for: 24148
Name: MOODY, REX C
License Type: Dentist
Primary Status: Cancelled
Secondary Status: Reduced Renewal Fee
Previous Names: MOODY, REX CALVERT
Address of Record
507 N SULLIVAN STE 120
SPOKANE VALLEY WA 99037
Map
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: MOODY & NICHOLS DDS, INC.
License/Registration Type: Additional Office Permit
License Number: 5675 Primary Status: Cancelled
Address :
26302 LA PAZ RD STE 102
MISSION VIEJO CA 92691
ORANGE COUNTY
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: MOODY, NICHOLLS & CUMMINGS, DDS, INC.
License/Registration Type: Additional Office Permit
License Number: 8372 Primary Status: Cancelled
Address :
360 SAN MIGUEL DR, STE 402
NEWPORT BEACH CA 92660
ORANGE COUNTY
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: MOODY & NICHOLLS, DDS
License/Registration Type: Additional Office Permit
License Number: 7242 Primary Status: Cancelled
Address :
360 SAN MIGUEL ROAD #402
NEWPORT BEACH CA 92660
ORANGE COUNTY
GA to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: General Anesthesia Permit
Name: MOODY, REX C
License/Registration Type: General Anesthesia Permit
License Number: 381 Primary Status: Cancelled
Address :
26302 LA PAZ RD STE 102
MISSION VIEJO CA 92691
ORANGE COUNTY
