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Licensing details for: 7964

Name: FARAJZADEH - BAKER, A PROFESSIONAL DENTAL CORP

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

6794 LA JOLLA BLVD
LA JOLLA CA 92037
SAN DIEGO county
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Issuance Date

May 9, 2003

Expiration Date

March 31, 2006

Current Date / Time

June 6, 2025
2:32:9 AM

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: BAKER, BRUCE BAKHSHI

License/Registration Type: Dentist License

License Number: 32267 Primary Status: Voluntary Surrendered

Address :
PO BOX 669
POWAY CA 92074
SAN DIEGO 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: FARAJZADEH, EDWARD

License/Registration Type: Dentist License

License Number: 33031 Primary Status: Current - Active

Address :
13983 Mango Dr
106
DEL MAR CA 92014-3131
SAN DIEGO COUNTY

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