Dental Board of California
Licensing details for: 103054
Name: STOUT, MICHAEL JAMES
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by Residency
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: MAKADIA AND STOUT DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81343 Primary Status: Current - Active
Address :
3967 MISSOURI FLAT ROAD., SUITE 120
PLACERVILLE CA 95667
EL DORADO 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: STOUT DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80732 Primary Status: Cancelled
Address :
3967 MISSOURI FLAT ROAD, SUITE 120
PLACERVILLE CA 95667
EL DORADO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MISSOURI FLAT DENTAL GROUP, MAKADIA AND STOUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17455 Primary Status: Current - Active
Address :
3967 MISSOURI FLAT ROAD., SUITE 120
PLACERVILLE CA 95667
EL DORADO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MISSOURI FLAT DENTAL GROUP, STOUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16164 Primary Status: Cancelled
Address :
3967 MISSOURI FLAT ROAD., SUITE 120
PLACERVILLE CA 95667
EL DORADO 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: MISSOURI FLAT DENTAL GROUP, STOUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16164 Primary Status: Cancelled
Address :
3967 MISSOURI FLAT ROAD., SUITE 120
PLACERVILLE CA 95667
EL DORADO 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: MISSOURI FLAT DENTAL GROUP, MAKADIA AND STOUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17455 Primary Status: Current - Active
Address :
3967 MISSOURI FLAT ROAD., SUITE 120
PLACERVILLE CA 95667
EL DORADO COUNTY
