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Licensing details for: 10773

Name: ENSIEH MAZAHERI, DDS, INC.

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Previous Names: ENSIEH MAZAHERI DDS INC

Address of Record

13060 GLENOAKS BLVD. #105-B
SYLMAR CA 91342
LOS ANGELES county
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Issuance Date

July 25, 2012

Expiration Date

November 30, 2012

Current Date / Time

June 6, 2025
8:48:52 PM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: GHAZAL, CAROLYN G

License/Registration Type: Dentist License

License Number: 38682 Primary Status: Current - Active

Address :
10797 FOOTHILL BLVD
RANCHO CUCAMONGA CA 91730
SAN BERNARDINO COUNTY

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AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Name: MAZAHERI, ENSIEH HOURA

License/Registration Type: Dentist License

License Number: 51699 Primary Status: Expired

Address :
4762 PARK GRANADA #265
CALABASAS CA 91302
LOS ANGELES COUNTY

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