Dental Board of California
Licensing details for: 2712
Name: ANAHEIM GENTAL DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
408 S. BEACH BLVD SUITE 104
ANAHEIM CA 92804
ORANGE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WYNN, MICHAEL MINH
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: WYNN, MICHAEL MINH
License/Registration Type: Dentist License
License Number: 44900 Primary Status: Current - Active
Address :
408 S Beach Blvd Ste 210
ANAHEIM CA 92804-1887
ORANGE COUNTY
