Dental Board of California
Licensing details for: 15891
Name: CITY FAMILY DENTAL AND IMPLANT CENTRE DENTAL PRACTICE OF ALTWAL AND SHELAT DDS INC
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ALTWAL, IYAD W
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SHELAT, BHAVINI HARISH
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: SHELAT, BHAVINI HARISH
License/Registration Type: Dentist License
License Number: 56738 Primary Status: Current - Active
Address :
4232 ACCLAIM WAY
MODESTO CA 95356
STANISLAUS 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: ALTWAL, IYAD W
License/Registration Type: Dentist License
License Number: 54407 Primary Status: Current - Active
Address :
761 John Kamps Way
RIPON CA 95366-9472
SAN JOAQUIN COUNTY
