Dental Board of California
Licensing details for: 100140
Name: SWAYAMPRAKASAM, LOGESH
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by Credential
License Relationships
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: SWAYAMPRAKASAM, LOGESH
License/Registration Type: Conscious Sedation Permit
License Number: 1189 Primary Status: Cancelled
Address :
4688 Mowry Ave
FREMONT CA 94538-1148
ALAMEDA COUNTY
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: SWAYAMPRAKASAM, LOGESH
License/Registration Type: Conscious Sedation Permit
License Number: 1057 Primary Status: Cancelled
Address :
750 N. CAPITOL AVE, STE. A
SAN JOSE CA 95133
SANTA CLARA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: SEASIDE PERIO CENTRE DR. L SWAYAMPRAKASAM DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 14370 Primary Status: Expired
Address :
43625 MISSION BLVD, STE 105
FREMONT CA 94539
ALAMEDA COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: SEASIDE PERIO CENTRE DR. L SWAYAMPRAKASAM DENTAL GROUP
License/Registration Type: Fictitious Name Permit
License Number: 14370 Primary Status: Expired
Address :
43625 MISSION BLVD, STE 105
FREMONT CA 94539
ALAMEDA COUNTY
MS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Moderate Sedation Permit
Name: SWAYAMPRAKASAM, LOGESH
License/Registration Type: Moderate Sedation Permit
License Number: 498 Primary Status: Current - Active
Address :
1761 E. CAPITOL EXPY
SAN JOSE CA 95121
SANTA CLARA COUNTY
