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Licensing details for: 13972

Name: MARCONI FAMILY DENTAL & SPECIALTY GROUP, A DENTAL PRACTICE OF R.T. HAYASHI, DDS., INC.

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

5723 MARCONI AVE STE A
CARMICHAEL CA 95608
SACRAMENTO county
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Practice Location

5723 MARCONI AVE STE A
CARMICHAEL CA 95608
SACRAMENTO county
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Issuance Date

January 8, 2018

Expiration Date

November 30, 2021

Current Date / Time

June 6, 2025
2:6:25 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: HAYASHI, RANDALL TOYSON

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: HAYASHI, RANDALL TOYSON

License/Registration Type: Dentist License

License Number: 36765 Primary Status: Current - Active

Address :
8102 Pollard Ave
FAIR OAKS CA 95628-6059
SACRAMENTO COUNTY

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