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Licensing details for: 18202

Name: PLAZA DENTAL GROUP DENTAL GROUP OF RICHARD C. EVANGELISTA, DDS

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

4205 SAN FELIPE ROAD., SUITE 200
SAN JOSE CA 95135
SANTA CLARA county
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Practice Location

4205 SAN FELIPE ROAD., SUITE 200
SAN JOSE CA 95135
SANTA CLARA county
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Issuance Date

October 24, 2023

Expiration Date

August 31, 2024

Current Date / Time

June 6, 2025
2:55:20 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: EVANGELISTA, RICHARD CARLOS

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: EVANGELISTA, RICHARD CARLOS

License/Registration Type: Dentist License

License Number: 47258 Primary Status: Current - Active

Address :
450 Sutter St
#2633
SAN FRANCISCO CA 94108-4206
SAN FRANCISCO COUNTY

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