Dental Board of California
Licensing details for: 17391
Name: SPROUT PEDIATRIC DENTISTRY, DENTAL PRACTICE OF JOSEPH PARK DDS INC
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: Joseph Park DDS Inc
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PARK, JOSEPH
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: PARK, JOSEPH
License/Registration Type: Dentist License
License Number: 64009 Primary Status: Current - Active
Address :
925 W Foothill Blvd Ste C
MONROVIA CA 91016-1930
LOS ANGELES COUNTY
