Dental Board of California
Licensing details for: 1045
Name: KHODAI, SHAHRAM
License Type: Oral Conscious Sedation
Primary Status: Expired
Specialty: Adult
Secondary Status: Licensure by Residency
Address of Record
1501 Secret Ravine Pkwy
1224
ROSEVILLE CA 95661-6000
PLACER county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: DREAM SMILES DENTAL, DENTAL OFFICE OF DR. SHAHRAM J. KHODAI
License/Registration Type: Fictitious Name Permit
License Number: 8810 Primary Status: Cancelled
Address :
3984 DOUGLAS BLVD.
STE. 170
ROSEVILLE CA 95661
PLACER COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: SMILE DESIGNS OF ROCKLIN, DENTAL OFFICE OF
License/Registration Type: Fictitious Name Permit
License Number: 5181 Primary Status: Cancelled
Address :
6000 FAIRWAY, STE 18
ROCKLIN CA 95677
PLACER COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: STANFORD RANCH DENTAL OFFICE
License/Registration Type: Fictitious Name Permit
License Number: 3403 Primary Status: Cancelled
Address :
6000 FAIRWAY STE #18
ROCKLIN CA 95677
PLACER COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Oral Conscious Sedation Certificate
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: KHODAI, SHAHRAM
License/Registration Type: Dentist License
License Number: 43027 Primary Status: Current - Active
Address :
3517 Marconi Ave #105
SACRAMENTO CA 95821
SACRAMENTO COUNTY
