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Licensing details for: 79367

Name: KESHTKAR DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

781 Sterling Pkwy
LINCOLN CA 95648-7320
PLACER county
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Practice Location

781 STERLING PARKWAY
LINCOLN CA 95648
PLACER county
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Issuance Date

June 30, 2017

Expiration Date

January 31, 2021

Current Date / Time

June 6, 2025
8:58:0 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: LOPEZ, MICHAEL JAMES

License/Registration Type: Dentist License

License Number: 57591 Primary Status: Current - Active

Address :
1556 Aria Ct
LIVERMORE CA 94550-6077
ALAMEDA COUNTY

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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: GILL, AMARDEEP KAUR

License/Registration Type: Dentist License

License Number: 50464 Primary Status: Current - Active

Address :
1450 E Main St
Ste 100
WOODLAND CA 95776-6201
YOLO COUNTY

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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: PATEL, DHAVAL RAMAN

License/Registration Type: Dentist License

License Number: 54297 Primary Status: Current - Active

Address :
10357 Fairway Dr
Ste 100
ROSEVILLE CA 95678-3544
PLACER COUNTY

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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: KESHTKAR, ARDALAN

License/Registration Type: Dentist License

License Number: 63917 Primary Status: Current - Active

Address :
10 Sierra Gate Plz #130
ROSEVILLE CA 95678-6645
PLACER COUNTY

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