Dental Board of California
Licensing details for: 2115
Name: MANGRUM, YOLANDA MARYE
License Type: Oral Conscious Sedation
Primary Status: Current - Active
Specialty: Adult
Previous Names: MANGRUM, YOLANDA
Address of Record
1301 SOUTH POINT BLVD
PETALUMA CA 94954
SONOMA county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: PETALUMA DENTAL GROUP, MANGRUM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 8076 Primary Status: Cancelled
Address :
1430 E WASHINGTON STREET
PETALUMA CA 94954
SONOMA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: Mangrum Dental Corporation
License/Registration Type: Fictitious Name Permit
License Number: 17702 Primary Status: Current - Active
Address :
1301 SOUTHPOINT BLVD SUITE A
PETALUMA CA 94954-6867
SONOMA COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Oral Conscious Sedation Certificate
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: MANGRUM, YOLANDA MARYE
License/Registration Type: Dentist License
License Number: 44612 Primary Status: Current - Active
Address :
1301 SOUTHPOINT BLVD
SUITE A
PETALUMA CA 94954
SONOMA COUNTY
