Dental Board of California
Licensing details for: 20280
Name: CHAMPLAIN DENTISTRY DENTAL GROUP OF CHAMPLAIN DENTISTRY, INC.
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
1193 E Champlain Dr
FRESNO CA 93720
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: SOOD, KUNAL
License/Registration Type: Dentist License
License Number: 104953 Primary Status: Current - Active
Address :
1095 Herndon Ave
Ste102
CLOVIS CA 93612-0504
FRESNO 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: FAREID, BEVAN SHOGHI
License/Registration Type: Dentist License
License Number: 64702 Primary Status: Current - Active
Address :
4129 S Mooney Blvd #B
VISALIA CA 93277
TULARE 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: VICUNA, SERGIO
License/Registration Type: Dentist License
License Number: 53129 Primary Status: Current - Active
Address :
5004 S Land Park Dr
SACRAMENTO CA 95822-2504
SACRAMENTO 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
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
