Dental Board of California
Licensing details for: 54887
Name: BOUTROS, SHADI FIKRY
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Previous Names: BOUTROS, SHADI F
License Relationships
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 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
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: BOUTROS, SHADI FIKRY
License/Registration Type: General Anesthesia Permit
License Number: 1706 Primary Status: Current - Active
Address :
1038 Murrieta Blvd
LIVERMORE CA 94550-4158
ALAMEDA COUNTY
