Dental Board of California
Licensing details for: 101542
Name: LOPEZ, DENISE
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by Portfolio
Address of Record
2455 JEFFERSON BLVD STE 130
WEST SACRAMENTO CA 95691
YOLO 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: BAUTISTA AND GILL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81154 Primary Status: Current - Active
Address :
2455 JEFFERSON BLVD. SUITE 130
WEST SACRAMENTO CA 95691
YOLO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: SOUTH RIVER DENTAL GROUP, BAUTISTA AND GILL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17059 Primary Status: Current - Active
Address :
2455 JEFFERSON BLVD. SUITE 130
WEST SACRAMENTO CA 95691
YOLO 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: SOUTH RIVER DENTAL GROUP, BAUTISTA AND GILL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17059 Primary Status: Current - Active
Address :
2455 JEFFERSON BLVD. SUITE 130
WEST SACRAMENTO CA 95691
YOLO COUNTY
