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Licensing details for: 11294

Name: SERGIO VICUNA DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

4515 FERMI PLACE SUITE 106
DAVIS CA 95618
YOLO county
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Practice Location

4515 FERMI PLACE SUITE 106
DAVIS CA 95618
YOLO county
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Issuance Date

December 10, 2013

Expiration Date

June 30, 2023

Current Date / Time

June 6, 2025
10:33:37 AM

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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