Dental Board of California
Licensing details for: 9057
Name: TRACY SMILES MODERN DENTISTRY - MY KIDS DENTIST AND ORTHODONTICS
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: TRACY SMILES - MY KIDS DENTIST, GENERAL DENTAL GROUP OF DENTAL CO ❖ TRACY SMILES DENTAL GROUP - MY KIDS DENTIST
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: NAKAKI, ROBERT PAUL
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: NAKAKI, ROBERT PAUL
License/Registration Type: Dentist License
License Number: 28963 Primary Status: Current - Active
Address :
2288 DANIELS STREET
MANTECA CA 95337
SAN JOAQUIN COUNTY
