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Licensing details for: 11219

Name: RANCHO MIRAGE DENTAL GROUP, FREDERICK LEE AND CAROLYN GHAZAL DENT

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

72027 Highway 111
SUITE C
RANCHO MIRAGE CA 92270-4961
RIVERSIDE county
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Practice Location

72-027 HIGHWAY 111
SUITE C
RANCHO MIRAGE CA 92270
RIVERSIDE county
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Issuance Date

April 11, 2014

Expiration Date

June 30, 2018

Current Date / Time

June 6, 2025
10:1:30 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GHAZAL, CAROLYN G

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LEE, FREDERICK HYUN WOO

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: RYGG, LANCE CHRISTIAN

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: NOSTI, JOHN CHARLES

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: NOSTI, JOHN CHARLES

License/Registration Type: Dentist License

License Number: 48655 Primary Status: Current - Active

Address :
709 Center Dr Ste 101
SAN MARCOS CA 92069-2502
SAN DIEGO 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: LEE, FREDERICK HYUN WOO

License/Registration Type: Dentist License

License Number: 43359 Primary Status: Current - Active

Address :
4000 W. FLORIDA AVE.
HEMET CA 92545
RIVERSIDE 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: RYGG, LANCE CHRISTIAN

License/Registration Type: Dentist License

License Number: 30251 Primary Status: Cancelled

Address :
9862 E MISSION GORGE RD, STE E
SANTEE CA 92071
SAN DIEGO 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: 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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