Dental Board of California
Licensing details for: 60298
Name: CHANG, ANDREW ANCHU
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
2878 Campus Pkwy
STE 1
RIVERSIDE CA 92507-0966
RIVERSIDE 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: DAVID CARLISLE DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79266 Primary Status: Cancelled
Address :
2878 CAMPUS PKWY STE 1
RIVERSIDE CA 92507
RIVERSIDE COUNTY
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: PENAFLORIDA DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80235 Primary Status: Current - Active
Address :
2878 CAMPUS PKWY., SUITE 1
RIVERSIDE CA 92507
RIVERSIDE COUNTY
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: CHANG, ANDREW ANCHU
License/Registration Type: Conscious Sedation Permit
License Number: 745 Primary Status: Cancelled
Address :
5843 RAINBOW HILL ROAD
AGOURA HILLS CA 91301
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CANYON SPRINGS DENTAL GROUP PENAFLORIDA DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15251 Primary Status: Current - Active
Address :
2878 CAMPUS PKWY., SUITE 1
RIVERSIDE CA 92507
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CANYON SPRINGS DENTAL GROUP DAVID CARLISLE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13408 Primary Status: Cancelled
Address :
2878 CAMPUS PKWY STE 1
RIVERSIDE CA 92507
RIVERSIDE 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: CANYON SPRINGS DENTAL GROUP DAVID CARLISLE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13408 Primary Status: Cancelled
Address :
2878 CAMPUS PKWY STE 1
RIVERSIDE CA 92507
RIVERSIDE 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: CANYON SPRINGS DENTAL GROUP PENAFLORIDA DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15251 Primary Status: Current - Active
Address :
2878 CAMPUS PKWY., SUITE 1
RIVERSIDE CA 92507
RIVERSIDE 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: CHANG, ANDREW ANCHU
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 2634 Primary Status: Cancelled
Address :
2878 Campus Pkwy
Ste C-1
RIVERSIDE CA 92507-0966
RIVERSIDE COUNTY
