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Licensing details for: 110734

Name: SONI, AYESHA

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by ADEX

Address of Record

4738 SAN LUCAS WAY
SAN JOSE CA 95135
SANTA CLARA county
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Issuance Date

September 5, 2024

Expiration Date

July 31, 2027

Current Date / Time

June 5, 2026
9:26:10 PM

License Relationships

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: Park Place Dental Group, Inc.

License/Registration Type: Fictitious Name Permit

License Number: 20526 Primary Status: Current - Active

Address :
501 S. Reino Road, Suite G
NEWBURY PARK CA 91320

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