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Licensing details for: 8575

Name: MENIFEE SMILES DENTAL GROUP, CAROLYN GHAZAL AND MINH PHAM DENTAL

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Previous Names: MENIFEE SMILES DENTISTRY DENTAL GROUP, CAROLYN GHAZAL AND MINH PHAM DENTAL CORPORATION MENIFEE SMILES DENTISTRY AND ORTHODONTICS DENTAL GROUP

Address of Record

30406 Haun Rd
STE. 740
MENIFEE CA 92584-6816
RIVERSIDE county
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Practice Location

30406 HAUN ROAD
STE. 740
MENIFEE CA 92584
RIVERSIDE county
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Issuance Date

January 19, 2010

Expiration Date

June 30, 2018

Current Date / Time

June 6, 2025
10:10:27 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: GHAZAL, CAROLYN 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: 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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