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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

Address of Record

9484 BLACK MOUNTAIN ROAD, STE. E
SAN DIEGO CA 92126
SAN DIEGO county
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Practice Location

9484 BLACK MOUNTAIN ROAD, STE. E
SAN DIEGO CA 92126
SAN DIEGO county
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Issuance Date

January 11, 2013

Expiration Date

August 31, 2025

Current Date / Time

June 22, 2025
2:33:28 AM

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

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