Dental Board of California
Licensing details for: 16164
Name: MISSOURI FLAT DENTAL GROUP, STOUT 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: GILL, AMARDEEP KAUR
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: STOUT, MICHAEL JAMES
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LOPEZ, MICHAEL JAMES
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BAUTISTA, REYMOND CARBONELL
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: BAUTISTA, REYMOND CARBONELL
License/Registration Type: Dentist License
License Number: 56217 Primary Status: Current - Active
Address :
1221 Albright Walk
SACRAMENTO CA 95818-1682
SACRAMENTO 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: LOPEZ, MICHAEL JAMES
License/Registration Type: Dentist License
License Number: 57591 Primary Status: Current - Active
Address :
1556 Aria Ct
LIVERMORE CA 94550-6077
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: GILL, AMARDEEP KAUR
License/Registration Type: Dentist License
License Number: 50464 Primary Status: Current - Active
Address :
1450 E Main St
Ste 100
WOODLAND CA 95776-6201
YOLO 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: STOUT, MICHAEL JAMES
License/Registration Type: Dentist License
License Number: 103054 Primary Status: Current - Active
Address :
3967 Missouri Flat Rd
120
PLACERVILLE CA 95667-5250
EL DORADO COUNTY
