Dental Board of California
Licensing details for: 13470
Name: CITRUS HEIGHTS MODERN DENTISTRY DENTAL GROUP, GHAZAL AND RODGERS DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RODGERS, CHARLES FREDERICK
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: GHAZAL, CAROLYN G
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
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: RODGERS, CHARLES FREDERICK
License/Registration Type: Dentist License
License Number: 35324 Primary Status: Current - Active
Address :
131 W Ontario Ave
Suite 103
CORONA CA 92882-5274
RIVERSIDE COUNTY
