Dental Board of California
Licensing details for: 420
Name: DOUGLAS, SHANE MARK
License Type: Moderate Sedation Permit
Primary Status: Current - Active
Previous Names: DOUGLAS, SHANE M
License Relationships
MS to DDS or OMS or SP
License/Registration Role: Moderate Sedation Permit
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: DOUGLAS, SHANE MARK
License/Registration Type: Dentist License
License Number: 61439 Primary Status: Current - Active
Address :
3700 ATHERTON RD
ROCKLIN CA 95765
PLACER COUNTY
