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Licensing details for: 1149

Name: KHODAI, SHAHRYAR

License Type: Oral Conscious Sedation

Primary Status: Current - Active

Specialty: Adult

Address of Record

620 Lilja Ct
ROSEVILLE CA 95678-1344
PLACER county
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Practice Location

1980 Alamo Dr
Suite #A
VACAVILLE CA 95687-6110
SOLANO county
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Issuance Date

March 12, 2007

Expiration Date

September 30, 2026

Current Date / Time

June 6, 2025
10:20:24 AM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: LINCOLN DENTAL OFFICE, SHAHRYAR KHODAI, DDS

License/Registration Type: Fictitious Name Permit

License Number: 3628 Primary Status: Cancelled

Address :
520 COTTONWOOD STREET, STE 11
WOODLAND CA 95695
YOLO COUNTY

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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, SHAHRYAR

License/Registration Type: Dentist License

License Number: 47740 Primary Status: Current - Active

Address :
1980 Alamo Dr Ste A
VACAVILLE CA 95687-6110
SOLANO COUNTY

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