Dental Board of California
Licensing details for: 4511
Name: CHILDREN'S DENTAL SURGERY CENTER, A DENTAL PRACTICE OF
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Partnership
Address of Record
1610 WEST EDINGER AVE, STE C
SANTA ANA CA 92704
ORANGE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MUNOZ, NUMA FERNANDO
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LEE, RICHARD SANG
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: LEE, RICHARD SANG
License/Registration Type: Dentist License
License Number: 44807 Primary Status: Current - Active
Address :
100 E VALENCIA MESA DR
Suite 102
FULLERTON CA 92835
ORANGE COUNTY
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: MUNOZ, NUMA FERNANDO
License/Registration Type: Dentist License
License Number: 46894 Primary Status: Cancelled
Address :
7835 Lakeside Blvd Apt 946
BOCA RATON FL 33434-6265
PALM BEACH COUNTY
