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Licensing details for: 10385

Name: PARKWAY DENTAL GROUP AND ORTHODONTICS, MARK J. BROWN DENTAL CORPO

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Secondary Status: Cancelled at the Request of the LicenseePrimary Status Definition

Address of Record

781 STERLING PARKWAY
LINCOLN CA 95648
PLACER county
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Practice Location

781 STERLING PARKWAY
LINCOLN CA 95648
PLACER county
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Issuance Date

March 15, 2013

Expiration Date

August 31, 2017

Current Date / Time

June 6, 2025
10:1:11 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GHAZAL, CAROLYN G

Address Not Disclosed

FNP to DDS or OMS

License/Registration Role: Fictitious Name 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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