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Licensing details for: 10733

Name: NUT TREE SMILES DENTISTRY AND ORTHODONTICS, DENTAL GROUP OF MANTE

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

110 Nut Tree Pkwy
VACAVILLE CA 95687-3251
SOLANO county
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Practice Location

110 NUT TREE PARKWAY
VACAVILLE CA 95687
SOLANO county
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Issuance Date

September 13, 2013

Expiration Date

June 30, 2020

Current Date / Time

November 2, 2025
3:28:31 PM

License Relationships

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: MANTENA, USHA RASHMI

License/Registration Type: Dentist License

License Number: 46110 Primary Status: Current - Active

Address :
671 Elmira Rd # 130
VACAVILLE CA 95687-4655

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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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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: 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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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: LAMBRIDIS, DEAN

License/Registration Type: Dentist License

License Number: 51199 Primary Status: Current - Active

Address :
30831 MARSEILLE WAY
WESTLAKE VILLAGE CA 91362
VENTURA COUNTY

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