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Licensing details for: 14368

Name: GARDEN GROVE MEDICAL AND DENTAL SURGERY, DENTAL OFFICE MOHAMAD ABUL-FIELAT DDS INC

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

12828 HARBOR BLVD STE 210
GARDEN GROVE CA 92840
ORANGE county
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Practice Location

12828 HARBOR BLVD STE 210
GARDEN GROVE CA 92840
ORANGE county
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Issuance Date

July 30, 2018

Expiration Date

June 30, 2019

Current Date / Time

June 7, 2025
8:0:14 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ABUL-FIELAT, MOHAMMAD GAZI

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: ABUL-FIELAT, MOHAMMAD GAZI

License/Registration Type: Dentist License

License Number: 43302 Primary Status: Current - Active

Address :
14275 Pipeline Ave
CHINO CA 91710-5639
SAN BERNARDINO COUNTY

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