Dental Board of California
Licensing details for: 10573
Name: SMILE STREET PEDIATRIC DENTISTRY, DENTAL GROUP OF MARISSA FAELDAN
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
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: FAELDAN-SUAREZ, MARISSA VALMONTE
License/Registration Type: Dentist License
License Number: 58944 Primary Status: Current - Active
Address :
5432 Sepulveda Blvd
B
B
CULVER CITY CA 90230-5512
LOS ANGELES COUNTY
