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Licensing details for: 11776

Name: MISSOURI FLAT DENTAL GROUP, BROWN AND GHAZAL DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

3967 Missouri Flat Rd
SUITE 120
PLACERVILLE CA 95667-5250
EL DORADO county
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Practice Location

3967 MISSOURI FLAT ROAD
SUITE 120
PLACERVILLE CA 95667
EL DORADO county
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Issuance Date

December 24, 2014

Expiration Date

June 30, 2018

Current Date / Time

June 6, 2025
7:23:4 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: BROWN, MARK JONATHAN

Address Not Disclosed

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: LAMBRIDIS, DEAN

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GILL, AMARDEEP KAUR

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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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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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: BROWN, MARK JONATHAN

License/Registration Type: Dentist License

License Number: 58387 Primary Status: Current - Active

Address :
707 Zion St Ste C
NEVADA CITY CA 95959-2932
NEVADA COUNTY

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