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Licensing details for: 80388

Name: PRATIK MAKADIA DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

2610 REYNOLDS RANCH PKWY., SUITE 100
LODI CA 95240
SAN JOAQUIN county
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Practice Location

2610 REYNOLDS RANCH PKWY., SUITE 100
LODI CA 95240
SAN JOAQUIN county
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Issuance Date

November 26, 2019

Expiration Date

January 31, 2026

Current Date / Time

June 6, 2025
3:28:0 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: 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: 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: MAKADIA, PRATIK ASHVINKUMAR

License/Registration Type: Dentist License

License Number: 101080 Primary Status: Current - Active

Address Not Disclosed

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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