Dental Board of California
Licensing details for: 19340
Name: PARKS PEDIATRIC DENTISTRY, PARKS DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
2751 ROOSEVELT RD STE 203
SAN DIEGO CA 92106
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PARKS, BRETT DANIEL
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: PARKS, BRETT DANIEL
License/Registration Type: Dentist License
License Number: 107435 Primary Status: Current - Active
Address :
5363 Balboa Ave
SAN DIEGO CA 92117-6913
SAN DIEGO COUNTY
