Dental Board of California
Licensing details for: 12830
Name: CHILDREN'S DENTAL FUN ZONE OF KHAKNEGAR & RODEF DENTAL CORPORATION DENTAL PRACTICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: RODEF, FARIBORZ
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KHAKNEGAR, MOHAMMAD
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: KHAKNEGAR, MOHAMMAD
License/Registration Type: Dentist License
License Number: 58982 Primary Status: Current - Active
Address :
6024 Fallbrook Ave
Suite 201
WOODLAND HILLS CA 91367
LOS ANGELES COUNTY
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: RODEF, FARIBORZ
License/Registration Type: Dentist License
License Number: 38356 Primary Status: Current - Active
Address :
2233 E GARVEY AVE N
WEST COVINA CA 91791
LOS ANGELES COUNTY
