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Licensing details for: 456

Name: LOPEZ, ALEX DIAZ

License Type: Conscious Sedation

Primary Status: Cancelled

Address of Record

2814 CAMINO DOS RIOS #401
NEWBURY PARK CA 91320
VENTURA county
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Practice Location

868 Auto Center Drive
A
868 Auto Center Drive, A
PALMDALE CA 93551
LOS ANGELES county
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Issuance Date

December 20, 2004

Expiration Date

April 30, 2024

Current Date / Time

June 6, 2025
9:48:36 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: LOPEZ, ALEX DIAZ

License/Registration Type: Dentist License

License Number: 44012 Primary Status: Current - Active

Address :
868 Auto Center Dr
Suite A
PALMDALE CA 93551-4690
LOS ANGELES COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: ANTELOPE VALLEY DENTAL SURGERY CENTER DENTAL GROUP OF SNOW, NAKANO & LOPEZ PROFESSIONAL DENTAL CORPORATION

License/Registration Type: Fictitious Name Permit

License Number: 15280 Primary Status: Current - Active

Address :
868 AUTO CENTER DRIVE SUITE A
PALMDALE CA 93551
LOS ANGELES COUNTY

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