Dental Board of California
Licensing details for: 63137
Name: SHAH, SAMIR KISHORE
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
21001 SHERMAN WY
STE 13
CANOGA PARK CA 91303
LOS ANGELES 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: SHAH AND HUYNH DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79899 Primary Status: Expired
Address :
1403 ALLEN RD STE 1000
BAKERSFIELD CA 93314
KERN COUNTY
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: SHAH AND JEFFERSON DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79364 Primary Status: Current - Active
Address :
5353 GOSFORD ROAD, SUITE 103
BAKERSFIELD CA 93313
KERN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: DENTISTS OF BAKERSFIELD DENTAL GROUP SHAH AND HUYNH DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 14614 Primary Status: Current - Active
Address :
1403 ALLEN RD STE 1000
BAKERSFIELD CA 93314
KERN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GOSFORD VILLAGE DENTAL GROUP, SHAH AND JEFFERSON DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13597 Primary Status: Current - Active
Address :
5353 GOSFORD RD STE 103
BAKERSFIELD CA 93313
KERN 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: GOSFORD VILLAGE DENTAL GROUP, SHAH AND JEFFERSON DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13597 Primary Status: Current - Active
Address :
5353 GOSFORD RD STE 103
BAKERSFIELD CA 93313
KERN 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: DENTISTS OF BAKERSFIELD DENTAL GROUP SHAH AND HUYNH DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 14614 Primary Status: Current - Active
Address :
1403 ALLEN RD STE 1000
BAKERSFIELD CA 93314
KERN COUNTY
Registered Dental Hygienist Alternative Practice to Dentist
License/Registration Role: Dentist
Related Party Role: Registered Dental Hygienist Alternative Practice
Name: FILLMORE, KANDYCE ANN
License/Registration Type: Registered Dental Hygienist Alternative Practice
License Number: 140 Primary Status: Current - Active
Address Not Disclosed
