Dental Board of California
Licensing details for: 5649
Name: UNIVERSITY TOWNE DENTAL GROUP OF NICHOLSON
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
4150 REGENTS PARK ROW
STE 130
LA JOLLA CA 92037
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
