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Licensing details for: 17694

Name: CITRUS HEIGHTS MODERN DENTISTRY DENTAL GROUP, MOHINI PATEL DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

5925 BIRDCAGE CENTRE LANE, SUITE D105
CITRUS HEIGHTS CA 95610
SACRAMENTO county
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Practice Location

5925 BIRDCAGE CENTRE LANE, SUITE D105
CITRUS HEIGHTS CA 95610
SACRAMENTO county
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Issuance Date

March 6, 2023

Expiration Date

November 30, 2025

Current Date / Time

June 6, 2025
10:17:26 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: OH, YUN HWAN

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: JEONG, DONG JUN

Address Not Disclosed

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: BAUTISTA, REYMOND CARBONELL

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LOPEZ, MICHAEL JAMES

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: 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

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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: OH, YUN HWAN

License/Registration Type: Dentist License

License Number: 100297 Primary Status: Current - Active

Address :
3521 Arden Way
STE 101
DENTISTS OF ARDEN
SACRAMENTO CA 95864-2911

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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

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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

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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: JEONG, DONG JUN

License/Registration Type: Dentist License

License Number: 61931 Primary Status: Current - Active

Address :
10910 OLSEN DR. SUITE 100
RANCHO CORDOVA CA 95670
SACRAMENTO COUNTY

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