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Licensing details for: 17246

Name: CAPISTRANO DENTAL GROUP SHALINI SHAH DDS DENTAL GROUP INC

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Corporation

Address of Record

32112 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA 92675
ORANGE county
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Practice Location

32112 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA 92675
ORANGE county
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Issuance Date

July 12, 2022

Expiration Date

August 31, 2023

Current Date / Time

June 6, 2025
9:56:4 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: SHAH, SHALINI M

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: SHAH, SHALINI M

License/Registration Type: Dentist License

License Number: 51304 Primary Status: Current - Active

Address :
5942 Edinger Ave Ste 101
HUNTINGTON BEACH CA 92649-1774
ORANGE COUNTY

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