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Licensing details for: 9646

Name: WALERGA DENTAL GROUP, DENTAL CORPORATION OF CAROLYN GHAZAL AND CH

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

8008 WALERGA ROAD, STE. 100
ANTELOPE CA 95843
SACRAMENTO county
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Practice Location

8008 WALERGA ROAD, STE. 100
ANTELOPE CA 95843
SACRAMENTO county
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Issuance Date

December 7, 2011

Expiration Date

August 31, 2017

Current Date / Time

June 7, 2025
3:10:26 AM

License Relationships

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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