Dental Board of California
Licensing details for: 103704
Name: TULLY, NATHAN DEAN
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
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: NATHAN TULLY DETNAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81520 Primary Status: Current - Active
Address :
3601 PELANDALE AVENUE, SUITE D-1
MODESTO CA 95356
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: TULLY AND MOKBIL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81066 Primary Status: Cancelled
Address :
2228 FAIR OAKS BLVD
SACRAMENTO CA 95825
SACRAMENTO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MODESTO SMILES DENTISTRY DENTAL GROUP, NATHAN TULLY DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17843 Primary Status: Current - Active
Address :
3601 Pelandale Avenue
Suite D-1
MODESTO CA 95356
STANISLAUS COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: DENTISTS OF CAMPUS COMMONS DENTAL GROUP, TULLY AND MOKBIL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16853 Primary Status: Cancelled
Address :
2228 FAIR OAKS BLVD
SACRAMENTO CA 95825
SACRAMENTO 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: DENTISTS OF CAMPUS COMMONS DENTAL GROUP, TULLY AND MOKBIL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16853 Primary Status: Cancelled
Address :
2228 FAIR OAKS BLVD
SACRAMENTO CA 95825
SACRAMENTO 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 SMILES DENTISTRY DENTAL GROUP, NATHAN TULLY DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17843 Primary Status: Current - Active
Address :
3601 Pelandale Avenue
Suite D-1
MODESTO CA 95356
STANISLAUS COUNTY
