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Licensing details for: 13118

Name: ENCINO FAMILY DENTAL GROUP, OFFICE OF KIMIA & LORENZ DENTAL PARTNERSHIP

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Partnership

Address of Record

15720 VENTURA BLVD, UNIT 322
ENCINO CA 91436
LOS ANGELES county
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Practice Location

14912 Burbank Blvd
SHERMAN OAKS CA 91411-3609
LOS ANGELES county
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Issuance Date

October 28, 2016

Expiration Date

February 28, 2025

Current Date / Time

June 6, 2025
2:14:9 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: KIMIA, DARA

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LORENZ, BROCK JASON

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: KIMIA, DARA

License/Registration Type: Dentist License

License Number: 61127 Primary Status: Current - Active

Address :
16605 DEVINSHIRE ST
LOS ANGELES CA 91344
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: LORENZ, BROCK JASON

License/Registration Type: Dentist License

License Number: 61270 Primary Status: Current - Active

Address :
6622 Cedarwood Dr
HUNTINGTON BEACH CA 92648-6658
ORANGE COUNTY

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