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Licensing details for: 10089

Name: PARK WEST DENTAL GROUP AND ORTHODONTICS - MY KIDS DENTIST, NAKAKI

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

10928 TRINITY PARKWAY
STOCKTON CA 95219
SAN JOAQUIN county
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Issuance Date

August 14, 2012

Expiration Date

May 31, 2015

Current Date / Time

June 6, 2025
2:12:2 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: NAKAKI, ROBERT PAUL

Address Not Disclosed

FNP to DDS or OMS

License/Registration Role: Fictitious Name Permit

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

Name: NAKAKI, ROBERT PAUL

License/Registration Type: Dentist License

License Number: 28963 Primary Status: Current - Active

Address :
2288 DANIELS STREET
MANTECA CA 95337
SAN JOAQUIN COUNTY

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