Dental Board of California
Licensing details for: 60475
Name: SZUTZ, THOMAS RANDALL
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
401 KENILWORTH DR
STE 960
PETALUMA CA 94952
SONOMA county
Map
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: SZUTZ DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 11835 Primary Status: Current - Active
Address :
401 KENILWORTH DRIVE
SUITE 960
PETALUMA CA 94952
SONOMA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PETALUMA MODERN DENTISTRY DENTAL GROUP, SZUTZ DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 12076 Primary Status: Current - Active
Address :
401 KENILWORTH DRIVE, SUITE 960
PETALUMA CA 94952
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 MODERN DENTISTRY DENTAL GROUP, SZUTZ DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 12076 Primary Status: Current - Active
Address :
401 KENILWORTH DRIVE, SUITE 960
PETALUMA CA 94952
SONOMA COUNTY
