Dental Board of California
Licensing details for: 101094
Name: CASTANEDA FASSIOLI, CAROLYN ELIZABETH
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Previous Names: CASTANEDA FASSIOLI, CAROLYN
Address of Record
22706 Aspan St
Suite 602
LAKE FOREST CA 92630-1603
ORANGE county
Map
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Additional Office Permit
Name: CASTANEDA FASSIOLI DENTAL CORP.
License/Registration Type: Additional Office Permit
License Number: 80639 Primary Status: Cancelled
Address :
22706 ASPAN STREET, SUITE 602
LAKE FOREST CA 92630
ORANGE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: EVERSHINE DENTAL GROUP, CAROLYN CASTANEDA FASSIOLI, DDS
License/Registration Type: Fictitious Name Permit
License Number: 13969 Primary Status: Cancelled
Address :
3385 G ST STE B
MERCED CA 95340
MERCED COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: EVERSHINE DENTAL GROUP CAROLYN CASTANEDA FASSIOLI, DDS
License/Registration Type: Fictitious Name Permit
License Number: 15981 Primary Status: Current - Active
Address :
22706 ASPAN STREET., SUITE 602
LAKE FOREST CA 92630
ORANGE COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: EVERSHINE DENTAL GROUP CAROLYN CASTANEDA FASSIOLI, DDS
License/Registration Type: Fictitious Name Permit
License Number: 15981 Primary Status: Current - Active
Address :
22706 ASPAN STREET., SUITE 602
LAKE FOREST CA 92630
ORANGE COUNTY
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: EVERSHINE DENTAL GROUP, CAROLYN CASTANEDA FASSIOLI, DDS
License/Registration Type: Fictitious Name Permit
License Number: 13969 Primary Status: Cancelled
Address :
3385 G ST STE B
MERCED CA 95340
MERCED COUNTY
