Dental Board of California
Licensing details for: 12652
Name: CITY ORAL SURGERY DENTAL PRACTICE SHADI BOUTROS, DDS, MD AND ALEX ANTIPOV, DDS INC.
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
490 POST STREET, SUITE 1022
SAN FRANCISCO CA 94102
SAN FRANCISCO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ANTIPOV, ALEXANDER V
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BOUTROS, SHADI FIKRY
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: BOUTROS, SHADI FIKRY
License/Registration Type: Dentist License
License Number: 54887 Primary Status: Current - Active
Address :
1038 Murrieta Blvd
1038 Murrieta Blvd
LIVERMORE CA 94550-4158
ALAMEDA 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: ANTIPOV, ALEXANDER V
License/Registration Type: Dentist License
License Number: 50724 Primary Status: Current - Active
Address :
911 Reserve Dr Ste 150
ROSEVILLE CA 95678
PLACER COUNTY
