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Licensing details for: 15981

Name: EVERSHINE DENTAL GROUP CAROLYN CASTANEDA FASSIOLI, DDS

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

22706 ASPAN STREET., SUITE 602
LAKE FOREST CA 92630
ORANGE county
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Practice Location

22706 ASPAN STREET., SUITE 602
LAKE FOREST CA 92630
ORANGE county
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Issuance Date

September 14, 2020

Expiration Date

September 30, 2026

Current Date / Time

June 6, 2025
9:7:55 PM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: CASTANEDA FASSIOLI, CAROLYN ELIZABETH

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: CASTANEDA FASSIOLI, CAROLYN ELIZABETH

License/Registration Type: Dentist License

License Number: 101094 Primary Status: Current - Active

Address :
22706 Aspan St
Suite 602
LAKE FOREST CA 92630-1603
ORANGE COUNTY

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