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Licensing details for: 10997

Name: MARK J. BROWN DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

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

Address of Record

781 STERLING PARKWAY
LINCOLN CA 95648
PLACER county
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Practice Location

781 STERLING PARKWAY
LINCOLN CA 95648
PLACER county
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Issuance Date

April 30, 2013

Expiration Date

June 30, 2018

Current Date / Time

June 6, 2025
8:52:37 PM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: GHAZAL, CAROLYN G

License/Registration Type: Dentist License

License Number: 38682 Primary Status: Current - Active

Address :
10797 FOOTHILL BLVD
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO COUNTY

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