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Licensing details for: 18990

Name: PARK PLACE DENTAL GROUP, DENTAL CORPORATION OF JADE GILBERT

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

501 S. REINO ROAD, SUITE G
NEWBURY PARK CA 91320
VENTURA county
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Practice Location

501 S. REINO ROAD, SUITE G
NEWBURY PARK CA 91320
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Issuance Date

October 11, 2024

Expiration Date

October 31, 2026

Current Date / Time

June 6, 2025
2:3:21 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GILBERT, JADE

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: HUYNH, PHI CANH

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ZAKLAMA, KARIM MAGID

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GALSTYAN, MARTIN ARAMIS

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

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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: GALSTYAN, MARTIN ARAMIS

License/Registration Type: Dentist License

License Number: 61923 Primary Status: Current - Active

Address :
PO BOX 909
GLENDALE CA 91209
LOS ANGELES 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: HUYNH, PHI CANH

License/Registration Type: Dentist License

License Number: 56413 Primary Status: Current - Active

Address :
11700 Heliotrope Ct
BAKERSFIELD CA 93311-8751
KERN 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: GILBERT, JADE

License/Registration Type: Dentist License

License Number: 106208 Primary Status: Current - Active

Address :
1197 E Los Angeles Ave
Suite E
SIMI VALLEY CA 93065-2868
VENTURA COUNTY

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