Dental Board of California
Licensing details for: 65124
Name: SOROUSHIAN, VASNA
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
3125 Coffee Rd # 7
MODESTO CA 95355-1768
STANISLAUS 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: TAQAVI AND SOROUSHIAN DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80966 Primary Status: Expired
Address :
1540 N TRACY BLVD
TRACY CA 95367
STANISLAUS 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: SOROUSHIAN AND TAQAVI DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80113 Primary Status: Expired
Address :
91 GREGORY LN #9
PLEASANT HILL CA 94523
CONTRA COSTA 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: VASNA SOROUSHIAN, DDS
License/Registration Type: Additional Office Permit
License Number: 82162 Primary Status: Current - Active
Address :
91 GREGORY LANE #9
PLEASANT HILL CA 94523
CONTRA COSTA COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GRACE DENTAL OF TRACY DENTAL OFFICE OF DR. POUYAN TAQAVI
License/Registration Type: Fictitious Name Permit
License Number: 16225 Primary Status: Current - Active
Address :
1540 N TRACY BLVD
TRACY CA 95376
SAN JOAQUIN COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GRACE DENTAL OF MODESTO DENTAL OFFICE OF DR. POUYAN TAQAVI
License/Registration Type: Fictitious Name Permit
License Number: 16965 Primary Status: Current - Active
Address :
3125 COFFEE RD #7
MODESTO CA 95355
STANISLAUS COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: GRACE DENTAL OF PLEASANT HILL DENTAL OFFICE OF DR. POUYAN TAQAVI
License/Registration Type: Fictitious Name Permit
License Number: 16966 Primary Status: Current - Active
Address :
91 GREGORY LANE
PLEASANT HILL CA 94523
CONTRA COSTA 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: GRACE DENTAL OF PLEASANT HILL DENTAL OFFICE OF DR. POUYAN TAQAVI
License/Registration Type: Fictitious Name Permit
License Number: 16966 Primary Status: Current - Active
Address :
91 GREGORY LANE
PLEASANT HILL CA 94523
CONTRA COSTA 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: GRACE DENTAL OF MODESTO DENTAL OFFICE OF DR. POUYAN TAQAVI
License/Registration Type: Fictitious Name Permit
License Number: 16965 Primary Status: Current - Active
Address :
3125 COFFEE RD #7
MODESTO CA 95355
STANISLAUS 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: GRACE DENTAL OF TRACY DENTAL OFFICE OF DR. POUYAN TAQAVI
License/Registration Type: Fictitious Name Permit
License Number: 16225 Primary Status: Current - Active
Address :
1540 N TRACY BLVD
TRACY CA 95376
SAN JOAQUIN COUNTY
