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Licensing details for: 79535

Name: CAROLYN GHAZAL AND MICHAEL LOPEZ DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

6623 N RIVERSIDE DR STE 101
FRESNO CA 93722
FRESNO county
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Practice Location

6623 N RIVERSIDE DR STE 101
FRESNO CA 93722
FRESNO county
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Issuance Date

December 8, 2017

Expiration Date

June 30, 2022

Current Date / Time

June 6, 2025
8:54:17 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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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: 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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