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Licensing details for: 80639

Name: CASTANEDA FASSIOLI DENTAL CORP.

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

22706 ASPAN STREET, SUITE 602
LAKE FOREST CA 92630
ORANGE county
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Practice Location

22706 ASPAN STREET, SUITE 602
LAKE FOREST CA 92630
ORANGE county
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Issuance Date

August 20, 2020

Expiration Date

September 30, 2022

Current Date / Time

June 6, 2025
3:29:19 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: CASTANEDA FASSIOLI, CAROLYN ELIZABETH

License/Registration Type: Dentist License

License Number: 101094 Primary Status: Current - Active

Address :
22706 Aspan St
Suite 602
LAKE FOREST CA 92630-1603
ORANGE COUNTY

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