Dental Board of California
Licensing details for: 3181
Name: SMILE GALLERY DENTAL OFFICE
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
1107 E LINCOLN AVENUE #201
ORANGE CA 92865
ORANGE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DATU, DAVID MARTINEZ
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: DATU, DAVID MARTINEZ
License/Registration Type: Dentist License
License Number: 40568 Primary Status: Current - Active
Address :
1107 E. LINCOLN AVE, #201
ORANGE CA 92865
ORANGE COUNTY
