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Licensing details for: 12064

Name: HAYASHI DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

601 W KETTLEMAN LANE
SUITE B
LODI CA 95240
SAN JOAQUIN county
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Practice Location

601 W KETTLEMAN LANE
STE B
LODI CA 95240
SAN JOAQUIN county
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Issuance Date

November 9, 2015

Expiration Date

November 30, 2017

Current Date / Time

December 13, 2025
9:47:43 AM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: HAYASHI, RANDALL TOYSON

License/Registration Type: Dentist License

License Number: 36765 Primary Status: Current - Active

Address :
8102 Pollard Ave
FAIR OAKS CA 95628-6059
SACRAMENTO COUNTY

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