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Licensing details for: 18971

Name: PLEASANT GROVE DENTAL GROUP, DENTAL CORPORATION OF DHAVAL PATEL

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

10357 FAIRWAY DRIVE, SUITE 100
ROSEVILLE CA 95678
PLACER county
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Practice Location

10357 FAIRWAY DRIVE, SUITE 100
ROSEVILLE CA 95678
PLACER county
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Issuance Date

September 30, 2024

Expiration Date

January 31, 2026

Current Date / Time

June 6, 2025
7:4:31 PM

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: MOKBIL, AHMAD

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: PATEL, DHAVAL RAMAN

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: MOKBIL, AHMAD

License/Registration Type: Dentist License

License Number: 101058 Primary Status: Current - Active

Address :
1016 Riley St
1
1016 Riley St
FOLSOM CA 95630-3265

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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: PATEL, DHAVAL RAMAN

License/Registration Type: Dentist License

License Number: 54297 Primary Status: Current - Active

Address :
10357 Fairway Dr
Ste 100
ROSEVILLE CA 95678-3544
PLACER 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: 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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