Dental Board of California
Licensing details for: 13358
Name: MAIN STREET DENTAL GROUP, KHAZALI DENTAL CORPORATION
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: ELIE, ARASH
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KHAZALI, MARAL
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: HUYNH, PHI CANH
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JEFFERSON, WALTER
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: ELIE, ARASH
License/Registration Type: Dentist License
License Number: 47470 Primary Status: Current - Active
Address :
15740 GREENLEAF STREET
ENCINO CA 91436
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: KHAZALI, MARAL
License/Registration Type: Dentist License
License Number: 61929 Primary Status: Current - Active
Address :
452 Twin Oaks Ct
THOUSAND OAKS CA 91362-3166
VENTURA 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: HUYNH, PHI CANH
License/Registration Type: Dentist License
License Number: 56413 Primary Status: Current - Active
Address :
11700 Heliotrope Ct
BAKERSFIELD CA 93311-8751
KERN 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: JEFFERSON, WALTER
License/Registration Type: Dentist License
License Number: 53460 Primary Status: Current - Active
Address :
16475 SIERRA LAKES PKWY
STE 140
FONTANA CA 92336
SAN BERNARDINO COUNTY
