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Licensing details for: 745

Name: CHANG, ANDREW ANCHU

License Type: Conscious Sedation

Primary Status: Cancelled

Address of Record

5843 RAINBOW HILL ROAD
AGOURA HILLS CA 91301
LOS ANGELES county
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Issuance Date

July 28, 2011

Expiration Date

November 30, 2012

Current Date / Time

June 6, 2025
1:53:39 AM

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: CHANG, ANDREW ANCHU

License/Registration Type: Dentist License

License Number: 60298 Primary Status: Current - Active

Address :
2878 Campus Pkwy
STE 1
RIVERSIDE CA 92507-0966
RIVERSIDE COUNTY

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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

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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

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