Dental Board of California
Licensing details for: 64636
Name: AMEZCUA, OSVALDO
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: AMEZCUA DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79383 Primary Status: Current - Active
Address :
3290 ARENA BLVD STE 610
SACRAMENTO CA 95834
SACRAMENTO COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MARKET WEST DENTAL GROUP, AMEZCUA DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13639 Primary Status: Current - Active
Address :
3290 ARENA BLVD STE 610
SACRAMENTO CA 95834
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: MARKET WEST DENTAL GROUP, AMEZCUA DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13639 Primary Status: Current - Active
Address :
3290 ARENA BLVD STE 610
SACRAMENTO CA 95834
SACRAMENTO COUNTY
