Dental Board of California
Licensing details for: 47562
Name: SHOUSHTARI, BABAK
License Type: Dentist
Primary Status: Current - Active
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: LA JOLLA ENDODONTICS DENTAL GROUP OF BABAK SHOUSHTARI, D.M.D., INC.
License/Registration Type: Fictitious Name Permit
License Number: 18833 Primary Status: Current - Active
Address :
4130 LA JOLLA VILLAGE DR., SUITE 205
LA JOLLA CA 92037
SAN DIEGO 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: LA JOLLA ENDODONTICS DENTAL GROUP OF BABAK SHOUSHTARI, D.M.D., INC.
License/Registration Type: Fictitious Name Permit
License Number: 18833 Primary Status: Current - Active
Address :
4130 LA JOLLA VILLAGE DR., SUITE 205
LA JOLLA CA 92037
SAN DIEGO COUNTY
