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Licensing details for: 12999

Name: LAKE ELSINORE DENTAL GROUP DRS. SOHEIL & MARSHA LEVI

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

32235 Mission Trl
8, 9, 10
LAKE ELSINORE CA 92530-4527
RIVERSIDE county
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Practice Location

32235 MISSION TRAIL ROAD
SUITE 8, 9, 10
LAKE ELSINORE CA 92530
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Issuance Date

July 29, 2016

Expiration Date

December 31, 2018

Current Date / Time

June 6, 2025
10:15:40 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LEVI, SOHEIL PISHGAR

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LEVI, MARSHA TAVAKOLI

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: LEVI, MARSHA TAVAKOLI

License/Registration Type: Dentist License

License Number: 46223 Primary Status: Current - Active

Address :
6020 SEABLUFF DR #5
LOS ANGELES CA 90094
LOS ANGELES COUNTY

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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: LEVI, SOHEIL PISHGAR

License/Registration Type: Dentist License

License Number: 39195 Primary Status: Current - Active

Address :
6020 SEABLUFF DR #5
LOS ANGELES CA 90094
LOS ANGELES COUNTY

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