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Licensing details for: 11737

Name: BRENTWOOD SMILES DENTISTRY AND ORTHODONTICS DENTAL GROUP, AMARDEE

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

6660 Lone Tree Way
SUITE 7
BRENTWOOD CA 94513-5370
CONTRA COSTA county
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Practice Location

6660 LONE TREE WAY
SUITE 7
BRENTWOOD CA 94513
CONTRA COSTA county
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Issuance Date

December 5, 2014

Expiration Date

June 30, 2020

Current Date / Time

June 6, 2025
10:5:22 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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