Dental Board of California
Licensing details for: 44612
Name: MANGRUM, YOLANDA MARYE
License Type: Dentist
Primary Status: Current - Active
Previous Names: MANGRUM, YOLANDA
Address of Record
1301 SOUTHPOINT BLVD
SUITE A
PETALUMA CA 94954
SONOMA county
Map
License Relationships
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: PETALUMA DENTAL GROUP, MANGRUM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 8076 Primary Status: Cancelled
Address :
1430 E WASHINGTON STREET
PETALUMA CA 94954
SONOMA 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: PETALUMA DENTAL GROUP PRACTICE OF MANGRUM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 17702 Primary Status: Current - Active
Address :
1301 SOUTHPOINT BLVD SUITE A
PETALUMA CA 94954-6867
SONOMA COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: MANGRUM, YOLANDA MARYE
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 2115 Primary Status: Current - Active
Address :
1301 SOUTH POINT BLVD
PETALUMA CA 94954
SONOMA COUNTY
