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Licensing details for: 15783

Name: CHILDREN'S CHOICE DENTAL CARE DENTAL PRACTICE OF DR. PAGE HUDSON DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

1139 E KETTLEMAN LN
LODI CA 95240
SAN JOAQUIN county
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Practice Location

1139 E KETTLEMAN LN
LODI CA 95240
SAN JOAQUIN county
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Issuance Date

April 23, 2020

Expiration Date

September 30, 2020

Current Date / Time

June 7, 2025
9:48:29 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: HUDSON, PAGE ALLEN

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: HUDSON, PAGE ALLEN

License/Registration Type: Dentist License

License Number: 36249 Primary Status: Current - Active

Address :
5150 5th St
RAPID CITY SD 57701-6023
PENNINGTON COUNTY

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