Dental Board of California
Licensing details for: 20698
Name: Lathrop Modern Dentistry, Dental Group of Lathrop Modern Dentistry, Prof. Corp.
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
16748 Golden Valley Parkway
LATHROP CA 95330
SAN JOAQUIN county
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: LIN, KUANYU
License/Registration Type: Dentist License
License Number: 64558 Primary Status: Current - Active
Address :
16748 Golden Valley Pkwy
LATHROP CA 95330-7851
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: PHAM, PETER NGUYEN
License/Registration Type: Dentist License
License Number: 105741 Primary Status: Current - Active
Address :
16748 Golden Valley Pkwy
LATHROP CA 95330-7851
SAN JOAQUIN 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
