Dental Board of California
Licensing details for: 727
Name: BLACK, MISTY M
License Type: Conscious Sedation
Primary Status: Cancelled
Address of Record
5425 SHENANDOAH
LOS ANGELES CA 90056
LOS ANGELES county
Map
License Relationships
CS to DDS, OMS, or SP
License/Registration Role: Conscious Sedation Permit
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: BLACK, MISTY M
License/Registration Type: Dentist License
License Number: 59622 Primary Status: Current - Active
Address :
1509 Hawthorne Blvd
102
REDONDO BEACH CA 90278-3957
LOS ANGELES COUNTY
