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Licensing details for: 79232

Name: KHAZALI DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

4360-C E MAIN STREET
VENTURA CA 93003
VENTURA county
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Practice Location

4360-C E MAIN STREET
VENTURA CA 93003
VENTURA county
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Issuance Date

February 28, 2017

Expiration Date

September 30, 2026

Current Date / Time

September 7, 2025
8:39:47 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: KHAZALI, MARAL

License/Registration Type: Dentist License

License Number: 61929 Primary Status: Current - Active

Address :
452 Twin Oaks Ct
THOUSAND OAKS CA 91362-3166
VENTURA 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: HUYNH, PHI CANH

License/Registration Type: Dentist License

License Number: 56413 Primary Status: Current - Active

Address :
11700 Heliotrope Ct
BAKERSFIELD CA 93311-8751
KERN 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: JEFFERSON, WALTER

License/Registration Type: Dentist License

License Number: 53460 Primary Status: Current - Active

Address :
16475 SIERRA LAKES PKWY
STE 140
FONTANA CA 92336
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: ELIE, ARASH

License/Registration Type: Dentist License

License Number: 47470 Primary Status: Current - Active

Address :
15740 GREENLEAF STREET
ENCINO CA 91436
LOS ANGELES COUNTY

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