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Licensing details for: 79691

Name: LOPEZ DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

3601 PELANDALE AVE, STE D1
MODESTO CA 95356
STANISLAUS county
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Practice Location

3601 PELANDALE AVE, STE D1
MODESTO CA 95356
STANISLAUS county
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Issuance Date

May 30, 2018

Expiration Date

October 31, 2021

Current Date / Time

December 13, 2025
7:54:24 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: 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: BAUTISTA, REYMOND CARBONELL

License/Registration Type: Dentist License

License Number: 56217 Primary Status: Current - Active

Address :
1221 Albright Walk
SACRAMENTO CA 95818-1682
SACRAMENTO 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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