Dental Board of California
Licensing details for: 44012
Name: LOPEZ, ALEX DIAZ
License Type: Dentist
Primary Status: Current - Active
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: LOPEZ, ALEX DIAZ
License/Registration Type: Conscious Sedation Permit
License Number: 456 Primary Status: Cancelled
Address :
868 Auto Center Drive
A
868 Auto Center Drive, A
PALMDALE CA 93551
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: ANTELOPE VALLEY DENTAL SURGERY CENTER DENTAL GROUP OF SNOW, NAKANO & LOPEZ PROFESSIONAL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15280 Primary Status: Current - Active
Address :
868 AUTO CENTER DRIVE SUITE A
PALMDALE CA 93551
LOS ANGELES 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: ANTELOPE VALLEY DENTAL SURGERY CENTER DENTAL GROUP OF SNOW, NAKANO & LOPEZ PROFESSIONAL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15280 Primary Status: Current - Active
Address :
868 AUTO CENTER DRIVE SUITE A
PALMDALE CA 93551
LOS ANGELES 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: LOPEZ, ALEX DIAZ
License/Registration Type: Moderate Sedation Permit
License Number: 428 Primary Status: Current - Active
Address :
2814 CAMINO DOS RIOS #401
NEWBURY PARK CA 91320
VENTURA COUNTY
