Dental Board of California
Licensing details for: 5154
Name: CHILDREN'S DENTAL GROUP, SCOTT JACKS, DDS, INC.
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
2144 S. BRISTOL ST.
SANTA ANA CA 92704
ORANGE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JACKS, SCOTT THOMAS
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JACKS, SCOTT
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: JACKS, SCOTT THOMAS
License/Registration Type: Dentist License
License Number: 24464 Primary Status: Deceased
Address :
28 CENTERPOINTE DR
LA PALMA CA 90623
ORANGE COUNTY
