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Licensing details for: 1446

Name: ANTIPOV, ALEXANDER V

License Type: Dentist General Anesthesia

Primary Status: Current - Active

Address of Record

911 RESERVE DR
STE 150
ROSEVILLE CA 95678
PLACER county
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Issuance Date

June 24, 2008

Expiration Date

March 31, 2026

Current Date / Time

June 6, 2025
10:11:58 AM

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

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: BRUCEVILLE DENTAL SPECIALTIES- DENTAL OFFICE OF ALEX ANTIPOV DENTAL CORP

License/Registration Type: Fictitious Name Permit

License Number: 13629 Primary Status: Cancelled

Address :
8759 CENTER PKWY
SACRAMENTO CA 95823
SACRAMENTO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.

License/Registration Type: Fictitious Name Permit

License Number: 16150 Primary Status: Expired

Address :
911 RESERVE DR., STE 150
ROSEVILLE CA 95678
PLACER COUNTY

Map

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.

License/Registration Type: Fictitious Name Permit

License Number: 17050 Primary Status: Current - Active

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

Map

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: COSMO DENTAL, PRACTICE OF ANTIPOV DENTAL INC.

License/Registration Type: Fictitious Name Permit

License Number: 11611 Primary Status: Current - Active

Address :
490 POST ST STE 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: GALLERIA ORAL & MAXILLO-FACIAL SURGERY, DENTAL OFFICE OF ALEXANDE

License/Registration Type: Fictitious Name Permit

License Number: 9820 Primary Status: Current - Active

Address :
911 Reserve Dr
Suite 150
ROSEVILLE CA 95678-1343

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: MOSAIC ORAL & MAXILLOFACIAL SURGERY, A DENTAL OFFICE OF ALEXANDER

License/Registration Type: Fictitious Name Permit

License Number: 9118 Primary Status: Cancelled

Address :
3840 EL DORADO HILLS BOULEVARD
STE. 202
EL DORADO HILLS CA 95762
EL DORADO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: GALLERIA ORAL & MAXILLO-FACIAL SURGERY, DENTAL OFFICE OF ALEXANDE

License/Registration Type: Fictitious Name Permit

License Number: 7942 Primary Status: Cancelled

Address :
927 RESERVE DRIVE
STE. A
ROSEVILLE CA 95678
PLACER COUNTY

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GA to DDS or OMS or SP

License/Registration Role: General Anesthesia Permit

Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit

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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