Dental Board of California
Licensing details for: 17578
Name: SANDCASTLE PEDIATRIC DENTISTRY DENTAL PRACTICE OF MARK ORTEGA, DDS, INC.
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ORTEGA, MARK STEVEN
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: ORTEGA, MARK STEVEN
License/Registration Type: Dentist License
License Number: 101523 Primary Status: Current - Active
Address :
5175 E Pacific Coast Hwy
204
LONG BEACH CA 90804-3317
LOS ANGELES COUNTY
