Dental Board of California
Licensing details for: 101387
Name: MANNEM, SASI KALA
License Type: Dentist
Primary Status: Current - Active
Address of Record
10928 Parkwest Dental Group
STOCKTON CA 95219
SAN JOAQUIN county
Map
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: MANNEM AND GHAZAL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79978 Primary Status: Current - Active
Address :
10928 TRINITY PKWY
STOCKTON CA 95219
SAN JOAQUIN COUNTY
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: MANNEM DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81157 Primary Status: Cancelled
Address :
2103 MCHENRY AVENUE., SUITE C
MODESTO CA 95350
STANISLAUS COUNTY
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: SASI MANNEM, DDS
License/Registration Type: Additional Office Permit
License Number: 82145 Primary Status: Current - Active
Address :
2103 MCHENRY AVE., SUITE C
MODESTO CA 95350
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MODESTO MODERN DENTISTRY DENTAL GROUP, MANNEM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17060 Primary Status: Current - Active
Address :
2103 MCHENRY AVENUE, SUITE C
MODESTO CA 95350
STANISLAUS COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PARK WEST DENTAL GROUP MANNEM AND GHAZAL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 14827 Primary Status: Current - Active
Address :
10928 TRINITY PKWY
STOCKTON CA 95219
SAN JOAQUIN 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: PARK WEST DENTAL GROUP MANNEM AND GHAZAL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 14827 Primary Status: Current - Active
Address :
10928 TRINITY PKWY
STOCKTON CA 95219
SAN JOAQUIN 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: MODESTO MODERN DENTISTRY DENTAL GROUP, MANNEM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17060 Primary Status: Current - Active
Address :
2103 MCHENRY AVENUE, SUITE C
MODESTO CA 95350
STANISLAUS COUNTY
