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Licensing details for: 16034

Name: SMILE SCENE DENTAL GROUP OF ALEX GLADKOV

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

1920 E 17TH ST., SUITE 110
SANTA ANA CA 92705
ORANGE county
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Practice Location

1920 E 17TH ST., SUITE 110
SANTA ANA CA 92705
ORANGE county
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Issuance Date

September 29, 2020

Expiration Date

April 30, 2024

Current Date / Time

June 7, 2025
8:30:57 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GLADKOV, ALEXANDRE GREGORY

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: GLADKOV, ALEXANDRE GREGORY

License/Registration Type: Dentist License

License Number: 40822 Primary Status: Current - Active

Address :
1920 E 17th St
Suite 100
SANTA ANA CA 92705
ORANGE COUNTY

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