Dental Board of California
Licensing details for: 35401
Name: HAGSTROM, RICHARD JOHN
License Type: Dentist
Primary Status: Current - Active
Previous Names: HAGSTROM, RICHARD J
Address of Record
8923 LA MESA BOULEVARD
LA MESA CA 91942
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: A SHOP FOR SMILES, DENTAL OFFICE OF RICHARD J. HAGSTROM DDS INC.
License/Registration Type: Fictitious Name Permit
License Number: 11446 Primary Status: Current - Active
Address :
8923 LA MESA BLVD
LA MESA CA 91942
SAN DIEGO 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: A SHOP FOR SMILES, DENTAL OFFICE OF RICHARD J. HAGSTROM DDS INC.
License/Registration Type: Fictitious Name Permit
License Number: 11446 Primary Status: Current - Active
Address :
8923 LA MESA BLVD
LA MESA CA 91942
SAN DIEGO COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: HAGSTROM, RICHARD JOHN
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 1202 Primary Status: Current - Active
Address :
8923 La Mesa Blvd
LA MESA CA 91942-9056
SAN DIEGO COUNTY
