Dental Board of California
Licensing details for: 16453
Name: LAKE BALBOA DENTAL GROUP PRACTICE OF SAM BARADARAN DDS, INC
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: BARADARAN, SAM
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: BARADARAN, SAM
License/Registration Type: Dentist License
License Number: 101275 Primary Status: Current - Active
Address Not Disclosed
