Dental Board of California
Licensing details for: 56210
Name: MCDONOUGH, SHAELAN DAVID
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
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: MCDONOUGH DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80972 Primary Status: Current - Active
Address :
12013 WILSHIRE BLVD
LOS ANGELES CA 90025
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: EAST OAKS DENTAL GROUP, MCDONOUGH AND HUSS DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 10750 Primary Status: Cancelled
Address :
593 N. MOORPARK ROAD SUITE B
THOUSAND OAKS CA 91360
VENTURA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: BRENTWOOD MODERN DENTISTRY DENTAL GROUP, MCDONOUGH DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16582 Primary Status: Current - Active
Address :
12013 WILSHIRE BLVD
LOS ANGELES CA 90025
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: BRENTWOOD MODERN DENTISTRY DENTAL GROUP, MCDONOUGH DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16582 Primary Status: Current - Active
Address :
12013 WILSHIRE BLVD
LOS ANGELES CA 90025
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: EAST OAKS DENTAL GROUP, MCDONOUGH AND HUSS DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 10750 Primary Status: Cancelled
Address :
593 N. MOORPARK ROAD SUITE B
THOUSAND OAKS CA 91360
VENTURA 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: MCDONOUGH, SHAELAN DAVID
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 1991 Primary Status: Cancelled
Address :
593 N MOORPARK RD
STE B
THOUSAND OAKS CA 91360
VENTURA COUNTY
