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Licensing details for: 80356

Name: LAMBRIDIS AND GHAFFARZADEGAN DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

1760 E. AVENIDA DE LOS ARBOLES, SUITE A
THOUSAND OAKS CA 91362
VENTURA county
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Practice Location

1760 E. AVENIDA DE LOS ARBOLES, SUITE A
THOUSAND OAKS CA 91362
VENTURA county
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Issuance Date

November 13, 2019

Expiration Date

June 30, 2027

Current Date / Time

June 6, 2025
2:26:54 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: GHAFFARZADEGAN, BAHARAK

License/Registration Type: Dentist License

License Number: 63623 Primary Status: Current - Active

Address :
1760 E. Avenida de los Arboles
Suite A
THOUSAND OAKS CA 91362
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: CHOKKA, SUDHAKAR RAO

License/Registration Type: Dentist License

License Number: 41376 Primary Status: Current - Active

Address :
27949 Greenspot Rd
Ste. H
HIGHLAND CA 92346-4443
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: 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: LAMBRIDIS, DEAN

License/Registration Type: Dentist License

License Number: 51199 Primary Status: Current - Active

Address :
30831 MARSEILLE WAY
WESTLAKE VILLAGE CA 91362
VENTURA COUNTY

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