Dental Board of California
Licensing details for: 40454
Name: KO, SAMUEL HYUNWOOK
License Type: Dentist
Primary Status: Current - Active
Address of Record
12429 MARIPOSA RD. SUITE A
VICTORVILLE CA 92395
SAN BERNARDINO 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: SAMUEL KO, DDS
License/Registration Type: Additional Office Permit
License Number: 7510 Primary Status: Cancelled
Address :
4654 EAST AVENUE "S" SUITE A
PALMDALE CA 93552
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: APPLE TOOTH DENTAL GROUP SAMUEL H. KO, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 12545 Primary Status: Current - Active
Address :
12429 MARIPOSA ROAD, SUITE A
VICTORVILLE CA 92395
SAN BERNARDINO 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: PALMDALE MARKETPLACE DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 1575 Primary Status: Cancelled
Address :
4654 E AVENUE S #A
PALMDALE CA 93552
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: APPLE TOOTH DENTAL GROUP SAMUEL H. KO, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 12127 Primary Status: Cancelled
Address :
15263 HOOK BLVD, SUITE D
VICTORVILLE CA 92394
SAN BERNARDINO 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: KO, SAMUEL HYUNWOOK
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 522 Primary Status: Cancelled
Address :
12429 MARIPOSA RD. SUITE A
VICTORVILLE CA 92395
SAN BERNARDINO COUNTY
Registered Dental Hygienist Alternative Practice to Dentist
License/Registration Role: Dentist
Related Party Role: Registered Dental Hygienist Alternative Practice
Name: THOMAS, JANNY MIRETTE
License/Registration Type: Registered Dental Hygienist Alternative Practice
License Number: 868 Primary Status: Current - Active
Address Not Disclosed
