Dental Board of California
Licensing details for: 11594
Name: PARK PLAZA CHILDREN'S DENTISTRY AND ORTHODONTICS, DENTAL OFFICE O
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JACKS, SCOTT THOMAS
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: JACKS, SCOTT THOMAS
License/Registration Type: Dentist License
License Number: 24464 Primary Status: Deceased
Address :
28 CENTERPOINTE DR
LA PALMA CA 90623
ORANGE COUNTY
