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Licensing details for: 22

Name: ANTIPOV, ALEXANDER V

License Type: Elective Facial Cosmetic Surgery

Primary Status: Current - Active

Expert Credentials: Category I Unlimited - OsteocartilaginousPrimary Status Definition

Qualification: Category II Unlimited - Soft TissuePrimary Status Definition

Address of Record

911 RESERVE DRIVE SUITE 150
ROSEVILLE CA 95678
PLACER county
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Active Status Location

911 Reserve Dr Ste 150
Suite 150
ROSEVILLE CA 95678-1343
PLACER county
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Issuance Date

March 11, 2013

Expiration Date

March 31, 2026

Current Date / Time

December 13, 2025
1:44:48 PM

License Relationships

FCS to DDS

License/Registration Role: Elective Facial Cosmetic Surgery Permit

Related Party Role: Must hold an active Dental License

Name: ANTIPOV, ALEXANDER V

License/Registration Type: Dentist License

License Number: 50724 Primary Status: Current - Active

Address :
911 Reserve Dr Ste 150
ROSEVILLE CA 95678
PLACER COUNTY

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