Dental Board of California
Licensing details for: 4095
Name: ACACIA DENTAL CARE, DENTAL PRACTICE OF
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Secondary Status: Cancelled at the Request of the Licensee
Address of Record
639 S ESCONDIDO BLVD
ESCONDIDO CA 92025
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WYNDHAMSMITH, DAVID RICHARD
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KIM, MICHAEL DUCKHYUN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WYNDHAMSMITH, DAVID R
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: KIM, MICHAEL DUCKHYUN
License/Registration Type: Dentist License
License Number: 42739 Primary Status: Current - Active
Address :
2002 S Hoover St
2002 S HOOVER ST
LOS ANGELES CA 90007-1323
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: WYNDHAMSMITH, DAVID RICHARD
License/Registration Type: Dentist License
License Number: 28413 Primary Status: Current - Active
Address :
1092 E Green St
PASADENA CA 91106-2506
LOS ANGELES COUNTY
