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Licensing details for: 3560

Name: ANTELOPE VALLEY DENTAL GROUP,

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

38655 9TH STREET EAST
PALMDALE CA 93550
LOS ANGELES county
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Issuance Date

March 12, 2002

Expiration Date

June 30, 2004

Current Date / Time

June 7, 2025
1:55:35 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: MICHELS, ALAN G

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: MICHELS, ALAN G

License/Registration Type: Dentist License

License Number: 19777 Primary Status: Current - Active

Address :
3529 Castleman Ln
BURBANK CA 91504-1663
LOS ANGELES COUNTY

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