Dental Board of California
Licensing details for: 58387
Name: BROWN, MARK JONATHAN
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: BROWN AND GHAZAL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 11645 Primary Status: Cancelled
Address :
3967 MISSOURI FLAT ROAD
SUITE 120
PLACERVILLE CA 95667
EL DORADO 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: BROWN AND GILL DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 11324 Primary Status: Cancelled
Address :
3000 DANVILLE BLVD SUITE A
ALAMO CA 94507
CONTRA COSTA 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: MARK J. BROWN, D.D.S., INC.
License/Registration Type: Additional Office Permit
License Number: 11508 Primary Status: Cancelled
Address :
2503 BELL ROAD
AUBURN CA 95603
PLACER COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MISSOURI FLAT DENTAL GROUP, BROWN AND GHAZAL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 11776 Primary Status: Cancelled
Address :
3967 MISSOURI FLAT ROAD
SUITE 120
PLACERVILLE CA 95667
EL DORADO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: ALAMO SMILES DENTAL GROUP, BROWN AND GILL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 11037 Primary Status: Cancelled
Address :
3000 DANVILLE BLVD
SUITE A
ALAMO CA 94507
CONTRA COSTA 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: MISSOURI FLAT DENTAL GROUP, BROWN AND GHAZAL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 11776 Primary Status: Cancelled
Address :
3967 MISSOURI FLAT ROAD
SUITE 120
PLACERVILLE CA 95667
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: ALAMO SMILES DENTAL GROUP, BROWN AND GILL DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 11037 Primary Status: Cancelled
Address :
3000 DANVILLE BLVD
SUITE A
ALAMO CA 94507
CONTRA COSTA COUNTY
Registered Dental Hygienist Alternative Practice to Dentist
License/Registration Role: Dentist
Related Party Role: Registered Dental Hygienist Alternative Practice
Name: De La Vega, Dawn Rae Kirsten
License/Registration Type: Registered Dental Hygienist Alternative Practice
License Number: 1052 Primary Status: Current - Active
Address Not Disclosed
Registered Dental Hygienist Alternative Practice to Dentist
License/Registration Role: Dentist
Related Party Role: Registered Dental Hygienist Alternative Practice
Name: SIMPSON, MARIA ELENA RANGEL
License/Registration Type: Registered Dental Hygienist Alternative Practice
License Number: 328 Primary Status: Current - Active
Address Not Disclosed
