Dental Board of California
Licensing details for: 13558
Name: BOUTIQUE FAMILY DENTISTRY DENTAL OFFICE OF DR. AVISHAN K. NASIRI
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: NASIRI, AVISHAN KOLAHDOUZ
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: NASIRI, AVISHAN KOLAHDOUZ
License/Registration Type: Dentist License
License Number: 64535 Primary Status: Current - Active
Address :
3500 Barranca Pkwy
Suite 270
IRVINE CA 92606
ORANGE COUNTY
