Dental Board of California
Licensing details for: 18279
Name: MORENO VALLEY MODERN DENTISTRY DENTAL GROUP, MYLAD DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MERCER, JUSTIN WILLIAM
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: DHAMA, DEEPIKA S
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MYLAD, BOTAMENA M
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SHAKIL, NIDA
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ZAKLAMA, KARIM MAGID
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: ZAKLAMA, KARIM MAGID
License/Registration Type: Dentist License
License Number: 61349 Primary Status: Current - Active
Address :
2700 E Workman Ave
WEST COVINA CA 91791-6625
LOS ANGELES 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: MYLAD, BOTAMENA M
License/Registration Type: Dentist License
License Number: 103690 Primary Status: Current - Active
Address :
24119 Hemlock Ave
STE 108
MORENO VALLEY CA 92557-7220
RIVERSIDE 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: SHAKIL, NIDA
License/Registration Type: Dentist License
License Number: 62089 Primary Status: Expired
Address :
19398 Fortunello Ave
RIVERSIDE CA 92508
RIVERSIDE 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: DHAMA, DEEPIKA S
License/Registration Type: Dentist License
License Number: 49044 Primary Status: Current - Active
Address :
2044 California Ave
CORONA CA 92881-3300
RIVERSIDE 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: MERCER, JUSTIN WILLIAM
License/Registration Type: Dentist License
License Number: 59375 Primary Status: Current - Active
Address :
3150 Case Rd Bldg C
PERRIS CA 92570-5552
RIVERSIDE COUNTY
