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Licensing details for: 46044

Name: DERAKSHAN, RAY

License Type: Dentist

Primary Status: Current - Active

Secondary Status: Reduced Renewal Fee

Previous Names: DERAKHSHAN, RAY DERAKHSHAN RAD, GHOLAM REZA

Address of Record

11134 RANCHO CARMEL DR
103
SAN DIEGO CA 92128
SAN DIEGO county
Map

Practice Location

11134 Rancho Carmel Drive
103
SAN DIEGO CA 92128
SAN DIEGO county
Map

Issuance Date

June 10, 1999

Expiration Date

March 31, 2027

Current Date / Time

April 5, 2026
4:44:59 AM

License Relationships

Registered Dental Hygienist Alternative Practice to Dentist

License/Registration Role: Dentist

Related Party Role: Registered Dental Hygienist Alternative Practice

Name: LOMELI, NATASHA RENEE

License/Registration Type: Registered Dental Hygienist Alternative Practice

License Number: 809 Primary Status: Current - Inactive

Address Not Disclosed

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