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Licensing details for: 3601

Name: PARK, JOSEPH

License Type: Oral Conscious Sedation

Primary Status: Cancelled

Specialty: Minor

Address of Record

925 W Foothill Blvd Ste C
MONROVIA CA 91016-1930
LOS ANGELES county
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Issuance Date

March 21, 2017

Expiration Date

December 31, 2017

Current Date / Time

June 6, 2025
10:6:47 PM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: Joseph Park DDS Inc

License/Registration Type: Fictitious Name Permit

License Number: 17391 Primary Status: Current - Active

Address :
925 W FOOTHILL BLVD STE C
MONROVIA CA 91016-1930
LOS ANGELES COUNTY

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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: PARK, JOSEPH

License/Registration Type: Dentist License

License Number: 64009 Primary Status: Current - Active

Address :
925 W Foothill Blvd Ste C
MONROVIA CA 91016-1930
LOS ANGELES COUNTY

Map

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