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Licensing details for: 5675

Name: MOODY & NICHOLS DDS, INC.

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

26302 LA PAZ RD STE 102
MISSION VIEJO CA 92691
ORANGE county
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Issuance Date

September 23, 1996

Expiration Date

May 31, 2000

Current Date / Time

June 7, 2025
7:41:35 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: MOODY, REX C

License/Registration Type: Dentist License

License Number: 24148 Primary Status: Cancelled

Address :
507 N SULLIVAN STE 120
SPOKANE VALLEY WA 99037

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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: NICHOLLS, DAVID W

License/Registration Type: Dentist License

License Number: 33505 Primary Status: Current - Active

Address :
26302 La Paz Rd Ste 102
MISSION VIEJO CA 92691-5327
ORANGE COUNTY

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