Dental Board of California
Licensing details for: 79364
Name: SHAH AND JEFFERSON DENTAL CORPORATION
License Type: Additional Office Permit
Primary Status: Current - Active
Organization Classification: Corporation
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: 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
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
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
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: SHAH, SAMIR KISHORE
License/Registration Type: Dentist License
License Number: 63137 Primary Status: Current - Active
Address :
21001 SHERMAN WY
STE 13
CANOGA PARK CA 91303
LOS ANGELES COUNTY
