Dental Board of California
Licensing details for: 10413
Name: HERITAGE OAK DENTAL, PRACTICE OF SHANE DOUGLAS, DDS PC
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
Previous Names: HERITAGE OAK DENTAL, PRACTICE OF DR. SHANE DOUGLAS
License Relationships
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: DOUGLAS, SHANE MARK
License/Registration Type: Dentist License
License Number: 61439 Primary Status: Current - Active
Address :
3700 ATHERTON RD
ROCKLIN CA 95765
PLACER COUNTY
