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Licensing details for: 79533

Name: ALEX G. GLADKOV DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

1500 E VILLAGE WAY STE D-43
ORANGE CA 92865
ORANGE county
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Practice Location

1500 E VILLAGE WAY STE D-43
ORANGE CA 92865
ORANGE county
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Issuance Date

November 30, 2017

Expiration Date

April 30, 2022

Current Date / Time

June 7, 2025
8:50:48 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: GLADKOV, ALEXANDRE GREGORY

License/Registration Type: Dentist License

License Number: 40822 Primary Status: Current - Active

Address :
1920 E 17th St
Suite 100
SANTA ANA CA 92705
ORANGE COUNTY

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