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: ANTIPOV DENTAL INC.
License/Registration Type: Additional Office Permit
License Number: 80938 Primary Status: Expired
Address :
490 POST STEET, STE. 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO COUNTY
FCS to DDS
License/Registration Role: Must hold an active Dental License
Related Party Role: Elective Facial Cosmetic Surgery Permit
Name: ANTIPOV, ALEXANDER V
License/Registration Type: Elective Facial Cosmetic Surgery Permit
License Number: 22 Primary Status: Current - Active
Address :
911 RESERVE DRIVE SUITE 150
ROSEVILLE CA 95678
PLACER COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: BRUCEVILLE DENTAL SPECIALTIES- DENTAL OFFICE OF ALEX ANTIPOV DENTAL CORP
License/Registration Type: Fictitious Name Permit
License Number: 13629 Primary Status: Cancelled
Address :
8759 CENTER PKWY
SACRAMENTO CA 95823
SACRAMENTO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GALLERIA ORAL & MAXILLO-FACIAL SURGERY, DENTAL OFFICE OF ALEXANDE
License/Registration Type: Fictitious Name Permit
License Number: 7942 Primary Status: Cancelled
Address :
927 RESERVE DRIVE
STE. A
ROSEVILLE CA 95678
PLACER COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 16150 Primary Status: Expired
Address :
911 RESERVE DR., STE 150
ROSEVILLE CA 95678
PLACER COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: CITY ORAL SURGERY DENTAL PRACTICE SHADI BOUTROS, DDS, MD AND ALEX ANTIPOV, DDS INC.
License/Registration Type: Fictitious Name Permit
License Number: 12652 Primary Status: Cancelled
Address :
490 POST STREET, SUITE 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: COSMO DENTAL, PRACTICE OF ANTIPOV DENTAL INC.
License/Registration Type: Fictitious Name Permit
License Number: 11611 Primary Status: Current - Active
Address :
490 POST ST STE 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GALLERIA ORAL & MAXILLO-FACIAL SURGERY, DENTAL OFFICE OF ALEXANDE
License/Registration Type: Fictitious Name Permit
License Number: 9820 Primary Status: Current - Active
Address :
911 Reserve Dr
Suite 150
ROSEVILLE CA 95678-1343
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MOSAIC ORAL & MAXILLOFACIAL SURGERY, A DENTAL OFFICE OF ALEXANDER
License/Registration Type: Fictitious Name Permit
License Number: 9118 Primary Status: Cancelled
Address :
3840 EL DORADO HILLS BOULEVARD
STE. 202
EL DORADO HILLS CA 95762
EL DORADO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 17050 Primary Status: Current - Active
Address :
911 Reserve Dr
Suite 150
ROSEVILLE CA 95678
PLACER 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: MOSAIC ORAL & MAXILLOFACIAL SURGERY, A DENTAL OFFICE OF ALEXANDER
License/Registration Type: Fictitious Name Permit
License Number: 9118 Primary Status: Cancelled
Address :
3840 EL DORADO HILLS BOULEVARD
STE. 202
EL DORADO HILLS CA 95762
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: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 16150 Primary Status: Expired
Address :
911 RESERVE DR., STE 150
ROSEVILLE CA 95678
PLACER 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: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.
License/Registration Type: Fictitious Name Permit
License Number: 17050 Primary Status: Current - Active
Address :
911 Reserve Dr
Suite 150
ROSEVILLE CA 95678
PLACER 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: BRUCEVILLE DENTAL SPECIALTIES- DENTAL OFFICE OF ALEX ANTIPOV DENTAL CORP
License/Registration Type: Fictitious Name Permit
License Number: 13629 Primary Status: Cancelled
Address :
8759 CENTER PKWY
SACRAMENTO CA 95823
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: GALLERIA ORAL & MAXILLO-FACIAL SURGERY, DENTAL OFFICE OF ALEXANDE
License/Registration Type: Fictitious Name Permit
License Number: 7942 Primary Status: Cancelled
Address :
927 RESERVE DRIVE
STE. A
ROSEVILLE CA 95678
PLACER 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: CITY ORAL SURGERY DENTAL PRACTICE SHADI BOUTROS, DDS, MD AND ALEX ANTIPOV, DDS INC.
License/Registration Type: Fictitious Name Permit
License Number: 12652 Primary Status: Cancelled
Address :
490 POST STREET, SUITE 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO 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: GALLERIA ORAL & MAXILLO-FACIAL SURGERY, DENTAL OFFICE OF ALEXANDE
License/Registration Type: Fictitious Name Permit
License Number: 9820 Primary Status: Current - Active
Address :
911 Reserve Dr
Suite 150
ROSEVILLE CA 95678-1343
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: COSMO DENTAL, PRACTICE OF ANTIPOV DENTAL INC.
License/Registration Type: Fictitious Name Permit
License Number: 11611 Primary Status: Current - Active
Address :
490 POST ST STE 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO COUNTY
GA 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: General Anesthesia Permit
Name: ANTIPOV, ALEXANDER V
License/Registration Type: General Anesthesia Permit
License Number: 1446 Primary Status: Current - Active
Address :
911 RESERVE DR
STE 150
ROSEVILLE CA 95678
PLACER COUNTY
