Dental Board of California
Licensing details for: 9597
Name: A TOOTH FAIRY DENTAL OFFICE, SOPHEAP TANG, DMD, DENTAL CORPORATIO
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: A TOOTH FAIRY DENTAL
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TANG, SOPHEAP
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: TANG, SOPHEAP
License/Registration Type: Dentist License
License Number: 56393 Primary Status: Current - Active
Address :
18876 Van Buren Blvd.
STE 107
RIVERSIDE CA 92508
RIVERSIDE COUNTY
