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Licensing details for: 61306

Name: RODRIGUEZ, NARDA S

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Previous Names: RODRIGUEZ, NARDA

Address of Record

20671 Lake Forest Dr
B 103
LAKE FOREST CA 92630-7746
ORANGE county
Map

Contract Location

20671 Lake Forest Dr
B 103
lake Forest
LAKE FOREST CA 92630-7746
ORANGE county
Map

Practice Location

20671 Lake Forest Dr
20671 Lake Forest Drive ste B 103
LAKE FOREST CA 92630-7746
ORANGE county
Map

Issuance Date

May 7, 2012

Expiration Date

January 31, 2026

Current Date / Time

June 6, 2025
3:15:22 PM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CALIFORNIA EASY SMILES DENTAL PRACTICE OF NARDA RODRIGUEZ, DMD, INC.

License/Registration Type: Fictitious Name Permit

License Number: 15382 Primary Status: Current - Active

Address :
20671 LAKE FOREST DR STE B103
LAKE FOREST CA 92630
ORANGE COUNTY

Map

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: CALIFORNIA EASY SMILES DENTAL PRACTICE OF NARDA RODRIGUEZ, DMD, INC.

License/Registration Type: Fictitious Name Permit

License Number: 15382 Primary Status: Current - Active

Address :
20671 LAKE FOREST DR STE B103
LAKE FOREST CA 92630
ORANGE COUNTY

Map

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