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Licensing details for: 9

Name: CALDEMEYER, CORTLAND S

License Type: Elective Facial Cosmetic Surgery

Primary Status: Cancelled

Expert Credentials: Category I Unlimited - OsteocartilaginousPrimary Status Definition

Qualification: Category II Unlimited - Soft TissuePrimary Status Definition

Previous Names: CALDEMEYER, CORTLAND CALDEMEYER, CORTLAND STEVEN

Address of Record

920 S. WILLOW AVENUE
COOKEVILLE TN 38501
PUTNAM county
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Active Status Location

5565 GROSSMONT CENTER DRIVE, BLDG 1, #129
LA MESA CA 91942
SAN DIEGO county
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Issuance Date

May 21, 2008

Expiration Date

June 30, 2017

Current Date / Time

June 7, 2025
9:37:14 PM

License Relationships

FCS to DDS

License/Registration Role: Elective Facial Cosmetic Surgery Permit

Related Party Role: Must hold an active Dental License

Name: CALDEMEYER, CORTLAND S

License/Registration Type: Dentist License

License Number: 47693 Primary Status: Cancelled

Address :
920 S WILLOW AVE
COOKEVILLE TN 38501
PUTNAM COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTER FOR ORAL & FACIAL SURGERY, DENTAL GROUP

License/Registration Type: Fictitious Name Permit

License Number: 3495 Primary Status: Cancelled

Address :
150 WEST MADISON AVE
EL CAJON CA 92020
SAN DIEGO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTER FOR ORAL & FACIAL SURGERY, DENTAL GROUP OF

License/Registration Type: Fictitious Name Permit

License Number: 4801 Primary Status: Cancelled

Address :
306 WALNUT AVE, STE 26
SAN DIEGO CA 92103
SAN DIEGO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTER FOR ORAL & FACIAL SURGERY, DENTAL GROUP

License/Registration Type: Fictitious Name Permit

License Number: 3494 Primary Status: Cancelled

Address :
306 WALNUT AVENUE, STE 26
SAN DIEGO CA 92103
SAN DIEGO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: CENTER FOR ORAL & FACIAL SURGERY, DENTAL GROUP OF

License/Registration Type: Fictitious Name Permit

License Number: 4786 Primary Status: Cancelled

Address :
150 W MADISON
EL CAJON CA 92020
SAN DIEGO COUNTY

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