Dental Board of California
Licensing details for: 36030
Name: WANG, SU-MIN
License Type: Dentist
Primary Status: Cancelled
Address of Record
24541 PACIFIC PARK DR STE 104
ALISO VIEJO CA 92656
ORANGE county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CHILDREN'S DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 732 Primary Status: Cancelled
Address :
SCOTT JACKS DDS INC
4444 TWEEDY BLVD
SOUTH GATE CA 90292
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: CHILDREN'S DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 732 Primary Status: Cancelled
Address :
SCOTT JACKS DDS INC
4444 TWEEDY BLVD
SOUTH GATE CA 90292
LOS ANGELES 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: WANG, SU-MIN
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 28 Primary Status: Cancelled
Address :
24541 PACIFIC PARK DR STE 104
ALISO VIEJO CA 92656
ORANGE COUNTY
