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Licensing details for: 16150

Name: GALLERIA ORAL & FACIAL SURGERY DENTAL OFFICE OF ALEXANDER V. ANTIPOV, D.D.S.

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

911 RESERVE DR., STE 150
ROSEVILLE CA 95678
PLACER county
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Practice Location

911 RESERVE DR., STE 150
ROSEVILLE CA 95678
PLACER county
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Issuance Date

December 1, 2020

Expiration Date

March 31, 2022

Current Date / Time

December 13, 2025
7:54:8 AM

License Relationships

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

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