Dental Board of California
Licensing details for: 732
Name: CHILDREN'S DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
SCOTT JACKS DDS INC
4444 TWEEDY BLVD
SOUTH GATE CA 90292
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WANG, SU MIN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TARNAVSKY, IRINA MIHAELA
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: WANG, SU-MIN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CANNON, JOSEPH
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JACKS, SCOTT
Address Not Disclosed
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: TURLEY, JERRID FRANCIS
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TURLEY, JERRY
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TARNAVSCHI, IRINA
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: CANNON, WILLIAM JOSEPH
License/Registration Type: Dentist License
License Number: 31582 Primary Status: Current - Active
Address :
1702 S Robertson Blvd
# 2 1 2
c/o Dr. W. J. Cannon
LOS ANGELES CA 90035-4316
LOS ANGELES 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: TARNAVSKY, IRINA MIHAELA
License/Registration Type: Dentist License
License Number: 30024 Primary Status: Current - Active
Address :
3256 Laurel Canyon Blvd
STUDIO CITY CA 91604-4130
LOS ANGELES 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: TURLEY, JERRID FRANCIS
License/Registration Type: Dentist License
License Number: 30866 Primary Status: Current - Active
Address :
5203 LAKEWOOD BLVD
LAKEWOOD CA 90712
LOS ANGELES 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: WANG, SU-MIN
License/Registration Type: Dentist License
License Number: 36030 Primary Status: Cancelled
Address :
24541 PACIFIC PARK DR STE 104
ALISO VIEJO CA 92656
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: JACKS, SCOTT THOMAS
License/Registration Type: Dentist License
License Number: 24464 Primary Status: Deceased
Address :
28 CENTERPOINTE DR
LA PALMA CA 90623
ORANGE COUNTY
