Dental Board of California
Licensing details for: 12150
Name: GREENHAVEN DENTAL CARE, DENTAL PRACTICE OF AZOUZ DENTAL CORP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Previous Names: GREENHAVEN DENTALCARE PRACTICE OF AZOUZ DENTAL CORP A CALIFORNIA PROFESSIONAL CORPORATION
Address of Record
930 FLORIN ROAD, SUITE 101
SACRAMENTO CA 95831
SACRAMENTO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: AZOUZ, DARRYL TODD
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: AZOUZ, DARRYL TODD
License/Registration Type: Dentist License
License Number: 47447 Primary Status: Current - Active
Address :
5414 Sunrise Blvd Ste F
CITRUS HEIGHTS CA 95610-7803
SACRAMENTO COUNTY
