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Licensing details for: 82031

Name: SERGIO VICUNA, DDS

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

4711 LAGUNA BLVD., SUITE 101
ELK GROVE CA 95758
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Practice Location

4711 LAGUNA BLVD., SUITE 101
ELK GROVE CA 95758
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Issuance Date

January 23, 2025

Expiration Date

June 30, 2025

Current Date / Time

June 7, 2025
5:1:14 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: VICUNA, SERGIO

License/Registration Type: Dentist License

License Number: 53129 Primary Status: Current - Active

Address :
5004 S Land Park Dr
SACRAMENTO CA 95822-2504
SACRAMENTO COUNTY

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