Dental Board of California
Licensing details for: 1202
Name: HAGSTROM, RICHARD JOHN
License Type: Oral Conscious Sedation
Primary Status: Current - Active
Specialty: Adult
Previous Names: HAGSTROM, RICHARD J
Address of Record
8923 La Mesa Blvd
LA MESA CA 91942-9056
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: A SHOP FOR SMILES, DENTAL OFFICE OF RICHARD J. HAGSTROM DDS INC.
License/Registration Type: Fictitious Name Permit
License Number: 11446 Primary Status: Current - Active
Address :
8923 LA MESA BLVD
LA MESA CA 91942
SAN DIEGO COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Oral Conscious Sedation Certificate
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: HAGSTROM, RICHARD JOHN
License/Registration Type: Dentist License
License Number: 35401 Primary Status: Current - Active
Address :
8923 LA MESA BOULEVARD
LA MESA CA 91942
SAN DIEGO COUNTY
