Dental Board of California
Licensing details for: 5589
Name: TIERRASANTA FAMILY DENTAL SPECIALTY, DENTAL GROUP OF
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
10715 TIERRASANTA BLVD, STE A
SAN DIEGO CA 92124
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: NICHOLSON, CHARLES SIMMS III
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: NICHOLSON, CHARLES SIMMS III
License/Registration Type: Dentist License
License Number: 20425 Primary Status: Expired
Address :
236 Jamacha Rd
101
EL CAJON CA 92019-2366
SAN DIEGO COUNTY
