
Dental Board of California
Licensing details for: 10274
Name: BLACK MOUNTAIN FAMILY DENTISTRY, DENTAL OFFICE OF SHADI KASTENHOL
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KASTENHOLZ, SHADI
Address Not Disclosed
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: KASTENHOLZ, SHADI
License/Registration Type: Dentist License
License Number: 56615 Primary Status: Current - Active
Address :
9484 BLACK MOUNTAIN RD#E
SAN DIEGO CA 92126
SAN DIEGO COUNTY