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Licensing details for: 81194

Name: BEVAN S. FAREID, D.D.S., INC.

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

827 AKERS STREET., SUITE 104
VISALIA CA 93277
TULARE county
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Practice Location

827 AKERS STREET., SUITE 104
VISALIA CA 93277
TULARE county
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Issuance Date

May 10, 2022

Expiration Date

July 31, 2025

Current Date / Time

June 6, 2025
8:52:2 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: LOPEZ, MICHAEL JAMES

License/Registration Type: Dentist License

License Number: 57591 Primary Status: Current - Active

Address :
1556 Aria Ct
LIVERMORE CA 94550-6077
ALAMEDA 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: VICUNA, SERGIO

License/Registration Type: Dentist License

License Number: 53129 Primary Status: Current - Active

Address :
5004 S Land Park Dr
SACRAMENTO CA 95822-2504
SACRAMENTO 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: FAREID, BEVAN SHOGHI

License/Registration Type: Dentist License

License Number: 64702 Primary Status: Current - Active

Address :
4129 S Mooney Blvd #B
VISALIA CA 93277
TULARE 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: PATEL, DHAVAL RAMAN

License/Registration Type: Dentist License

License Number: 54297 Primary Status: Current - Active

Address :
10357 Fairway Dr
Ste 100
ROSEVILLE CA 95678-3544
PLACER COUNTY

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