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Licensing details for: 5047

Name: PLEASANT GROVE DENTAL GROUP, BUEHLER, GHAZAL, RODGERS

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

10357 FAIRWAY DR, STE 100
ROSEVILLE CA 95678
PLACER county
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Issuance Date

June 29, 2004

Expiration Date

October 31, 2011

Current Date / Time

June 6, 2025
2:59:7 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: BUEHLER, BRIAN DONALD

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GHAZAL, CAROLYN G

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: RODGERS, CHARLES FREDERICK

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: RODGERS, CHARLES FREDERICK

License/Registration Type: Dentist License

License Number: 35324 Primary Status: Current - Active

Address :
131 W Ontario Ave
Suite 103
CORONA CA 92882-5274
RIVERSIDE 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: GHAZAL, CAROLYN G

License/Registration Type: Dentist License

License Number: 38682 Primary Status: Current - Active

Address :
10797 FOOTHILL BLVD
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO 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: BUEHLER, BRIAN DONALD

License/Registration Type: Dentist License

License Number: 38166 Primary Status: Current - Active

Address :
943 Pico Ste.A
SAN CLEMENTE CA 92673
ORANGE COUNTY

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