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Licensing details for: 80966

Name: TAQAVI AND SOROUSHIAN DENTAL CORPORATION

License Type: Additional Office Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

1540 N TRACY BLVD
TRACY CA 95367
STANISLAUS county
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Practice Location

1540 N TRACY BLVD
TRACY CA 95367
STANISLAUS county
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Issuance Date

June 30, 2021

Expiration Date

June 30, 2023

Current Date / Time

June 6, 2025
11:42:57 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: TAQAVI, POUYAN

License/Registration Type: Dentist License

License Number: 62710 Primary Status: Current - Active

Address :
1540 N Tracy Blvd
TRACY CA 95376-2903
STANISLAUS 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: SOROUSHIAN, VASNA

License/Registration Type: Dentist License

License Number: 65124 Primary Status: Current - Active

Address :
3125 Coffee Rd # 7
MODESTO CA 95355-1768
STANISLAUS COUNTY

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