Dental Board of California
Licensing details for: 9118
Name: MOSAIC ORAL & MAXILLOFACIAL SURGERY, A DENTAL OFFICE OF ALEXANDER
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: ANTIPOV, ALEXANDER V
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: ANTIPOV, ALEXANDER V
License/Registration Type: Dentist License
License Number: 50724 Primary Status: Current - Active
Address :
911 Reserve Dr Ste 150
ROSEVILLE CA 95678
PLACER COUNTY
