Dental Board of California
Licensing details for: 33967
Name: PARK, SOO TAE
License Type: Dentist
Primary Status: Current - Active
Secondary Status: Revoked, Stayed, Probation
Address of Record
18011 MARABOU PLACE
CANYON COUNTRY CA 91387
LOS ANGELES county
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: SOO T PARK, DDS
License/Registration Type: Additional Office Permit
License Number: 5471 Primary Status: Cancelled
Address :
15165 7TH ST STE I
VICTORVILLE CA 92392
SAN BERNARDINO 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: SOO TAE PARK, DDS
License/Registration Type: Additional Office Permit
License Number: 79703 Primary Status: Expired
Address :
8003 ALICANTE AVE
LAMONT CA 93241
KERN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PARK DENTAL GROUP, SOO T. PARK, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 5157 Primary Status: Cancelled
Address :
44841 N. 10TH STREET WEST
LANCASTER CA 93534
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: PARK DENTAL GROUP, SOO T. PARK, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 5157 Primary Status: Cancelled
Address :
44841 N. 10TH STREET WEST
LANCASTER CA 93534
LOS ANGELES COUNTY
