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Licensing details for: 13221

Name: SMILE WIDE DENTAL, GROUP OF BADII LEE DENTAL CORPORATION, INC.

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Secondary Status: Cancelled at the Request of the LicenseePrimary Status Definition

Address of Record

14600 SHERMAN WAY, #100B
VAN NUYS CA 91405
LOS ANGELES county
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Practice Location

14600 SHERMAN WAY, #100B
VAN NUYS CA 91405
LOS ANGELES county
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Issuance Date

December 13, 2016

Expiration Date

January 31, 2019

Current Date / Time

June 7, 2025
11:3:37 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LEE, DANIEL HARVEY

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: LEE, DANIEL HARVEY

License/Registration Type: Dentist License

License Number: 56861 Primary Status: Current - Active

Address :
14252 Culver Dr
Suite 831
IRVINE CA 92604-0317
ORANGE COUNTY

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