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Licensing details for: 11813

Name: ZEN DENTAL CARE, DENTAL PRACTICE OF MIRABEL CAYCO DDS

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Sole Owner

Previous Names: ZEN DENTAL CARE PRACTICE OF MIRABEL CAYCO DDS

Address of Record

2448 GUERNEVILLE ROAD
#1000
SANTA ROSA CA 95403
SONOMA county
Map

Practice Location

2448 GUERNEVILLE ROAD #1000
SANTA ROSA CA 95403
SONOMA county
Map

Issuance Date

January 16, 2015

Expiration Date

November 30, 2019

Current Date / Time

April 3, 2026
1:40:41 AM

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: CAYCO-TANGCO, MIRABEL H

License/Registration Type: Dentist License

License Number: 54421 Primary Status: Current - Active

Address Not Disclosed

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