Dental Board of California
Licensing details for: 20160
Name: Madison Modern Dentistry, Dental Group of Madison Modern Dentistry, Inc.
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
5315 Sunrise Blvd
FAIR OAKS CA 95628
Map
License Relationships
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: CONLON, COLLEEN ANITA
License/Registration Type: Dentist License
License Number: 106233 Primary Status: Current - Active
Address :
5315 Sunrise Blvd
FAIR OAKS CA 95628-3539
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
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
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
