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: KRISTY H. BAE, DDS, A PROF. DENTAL CORP.
License/Registration Type: Additional Office Permit
License Number: 10476 Primary Status: Current - Active
Address :
2005 B3E. PARK PLACE
EL SEGUNDO CA 90245
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MIRACLE SMILE DENTAL PRACTICE
License/Registration Type: Fictitious Name Permit
License Number: 3193 Primary Status: Current - Active
Address :
5850 WILSHIRE BLVD
LOS ANGELES CA 90036
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MIRACLE SMILE DENTAL PRACTICE OF K. HYOSONG BAE DDS, A PROFESSION
License/Registration Type: Fictitious Name Permit
License Number: 9338 Primary Status: Current - Active
Address :
2005-B3E PARK PLACE
EL SEGUNDO CA 90245
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: MIRACLE SMILE DENTAL PRACTICE OF K. HYOSONG BAE DDS, A PROFESSION
License/Registration Type: Fictitious Name Permit
License Number: 9338 Primary Status: Current - Active
Address :
2005-B3E PARK PLACE
EL SEGUNDO CA 90245
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: MIRACLE SMILE DENTAL PRACTICE
License/Registration Type: Fictitious Name Permit
License Number: 3193 Primary Status: Current - Active
Address :
5850 WILSHIRE BLVD
LOS ANGELES CA 90036
LOS ANGELES COUNTY
