Dental Board of California
Licensing details for: 12076
Name: PETALUMA MODERN DENTISTRY DENTAL GROUP, SZUTZ DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: PETALUMA MODERN DENTISTRY, SZUTZ DENTAL CORPORATION ❖ PETALUMA MODERN DENTISTRY DENTAL GROUP NOSTI AND GILL DENTAL CORPORATION ❖ PETALUMA MODERN DENTISTRY, DENTAL GROUP OF NOSTI AND GILL DENTAL CORPORATION
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: GILL, AMARDEEP KAUR
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: SZUTZ, THOMAS RANDALL
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: SZUTZ, THOMAS RANDALL
License/Registration Type: Dentist License
License Number: 60475 Primary Status: Current - Active
Address :
401 KENILWORTH DR
STE 960
PETALUMA CA 94952
SONOMA COUNTY
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
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
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
