Dental Board of California
Licensing details for: 13021
Name: ORANGE COUNTY CENTERS FOR ORAL SURGERY AND DENTAL IMPLANTS CUMMINGS, BALASANIAN, CAPUTO & NICHOLLS DENTAL GROUP INC.
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BALASANIAN, EDWARD
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: NICHOLLS, DAVID W
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CAPUTO, JEFFREY MARSHALL
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CUMMINGS, DAVID RAYMOND
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: BALASANIAN, EDWARD
License/Registration Type: Dentist License
License Number: 48702 Primary Status: Current - Active
Address :
1171 Puerta Del Sol
Suite D
SAN CLEMENTE CA 92673-6343
ORANGE COUNTY
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: CUMMINGS, DAVID RAYMOND
License/Registration Type: Dentist License
License Number: 39142 Primary Status: Current - Active
Address :
26302 LA PAZ ROAD
SUITE 102
MISSION VIEJO CA 92691
ORANGE COUNTY
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: NICHOLLS, DAVID W
License/Registration Type: Dentist License
License Number: 33505 Primary Status: Current - Active
Address :
26302 La Paz Rd Ste 102
MISSION VIEJO CA 92691-5327
ORANGE COUNTY
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: CAPUTO, JEFFREY MARSHALL
License/Registration Type: Dentist License
License Number: 55550 Primary Status: Current - Active
Address :
26302 LA PAZ RD
STE. 102
MISSION VIEJO CA 92691
ORANGE COUNTY
