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Licensing details for: 9222

Name: WELLCARE DENTAL GROUP OF STOCKTON, PRACTICE OF RANDALL T. HAYASHI

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Previous Names: WELLCARE DENTAL GROUP OF STOCKTON

Address of Record

1036 W ROBINHOOD DRIVE
STE. 104
STOCKTON CA 95207
SAN JOAQUIN county
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Practice Location

1036 W ROBINHOOD DRIVE
STE. 104
STOCKTON CA 95207
SAN JOAQUIN county
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Issuance Date

February 25, 2011

Expiration Date

November 30, 2011

Current Date / Time

June 6, 2025
3:1:7 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: HAYASHI, RANDALL TOYSON

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: HAYASHI, RANDALL TOYSON

License/Registration Type: Dentist License

License Number: 36765 Primary Status: Current - Active

Address :
8102 Pollard Ave
FAIR OAKS CA 95628-6059
SACRAMENTO COUNTY

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