Dental Board of California
Licensing details for: 5157
Name: PARK DENTAL GROUP, SOO T. PARK, DDS, INC.
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
44841 N. 10TH STREET WEST
LANCASTER CA 93534
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PARK, SOO TAE
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: PARK, SOO TAE
License/Registration Type: Dentist License
License Number: 33967 Primary Status: Current - Active
Address :
18011 MARABOU PLACE
CANYON COUNTRY CA 91387
LOS ANGELES COUNTY
