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Licensing details for: 3164

Name: ANTIPOVA, OLGA

License Type: Oral Conscious Sedation

Primary Status: Cancelled

Specialty: Adult

Address of Record

4145 SHADOW LANE #524
SANTA ROSA CA 95405
SONOMA county
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Issuance Date

April 10, 2014

Expiration Date

June 30, 2017

Current Date / Time

June 7, 2025
2:20:20 PM

License Relationships

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: ANTIPOVA, OLGA

License/Registration Type: Dentist License

License Number: 61522 Primary Status: Current - Active

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

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