Dental Board of California
Licensing details for: 3193
Name: MIRACLE SMILE DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
5850 WILSHIRE BLVD
LOS ANGELES CA 90036
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BAE, KRISTY HYOSONG
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: BAE, KRISTY HYOSONG
License/Registration Type: Dentist License
License Number: 43110 Primary Status: Current - Active
Address :
2005 B3E Park Place
EL SEGUNDO CA 90245
