Dental Board of California
Licensing details for: 11446
Name: A SHOP FOR SMILES, DENTAL OFFICE OF RICHARD J. HAGSTROM DDS INC.
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: HAGSTROM, RICHARD JOHN
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: HAGSTROM, RICHARD JOHN
License/Registration Type: Dentist License
License Number: 35401 Primary Status: Current - Active
Address :
8923 LA MESA BOULEVARD
LA MESA CA 91942
SAN DIEGO COUNTY
