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Licensing details for: 1192

Name: BEMBEY, KANIKA

License Type: Conscious Sedation

Primary Status: Cancelled

Secondary Status: Cancelled at the Request of the LicenseePrimary Status Definition

Address of Record

34483 ALBERTA TERRACE
FREMONT CA 94555
ALAMEDA county
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Practice Location

9640 BRUCEVILLE RD, STE. 101
ELK GROVE CA 95757
SACRAMENTO county
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Issuance Date

May 1, 2019

Expiration Date

April 8, 2020

Current Date / Time

June 6, 2025
1:52:12 AM

License Relationships

CS to DDS, OMS, or SP

License/Registration Role: Conscious Sedation Permit

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

Name: BEMBEY, KANIKA

License/Registration Type: Dentist License

License Number: 103138 Primary Status: Current - Active

Address :
6671 Agave Cir
CARLSBAD CA 92011-3617
SAN DIEGO COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: ENCINITAS PERIODONTICS AND DENTAL IMPLANTS DENTAL PRACTICE OF DR. KANIKA BEMBEY

License/Registration Type: Fictitious Name Permit

License Number: 16678 Primary Status: Current - Active

Address :
477 N. EL CAMINO REAL C306
ENCINITAS CA 92024
SAN DIEGO COUNTY

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