Dental Board of California
Licensing details for: 17530
Name: SHERMAN OAKS SMILES DENTAL OFFICE OF DRS. KIMIA, LORENZ, AND POULDAR
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Partnership
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KIMIA, DARA
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: POULDAR, EDWIN JAKOB
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LORENZ, BROCK JASON
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: POULDAR, EDWIN JAKOB
License/Registration Type: Dentist License
License Number: 105565 Primary Status: Current - Active
Address :
14912 Burbank Blvd
SHERMAN OAKS CA 91411-3609
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: KIMIA, DARA
License/Registration Type: Dentist License
License Number: 61127 Primary Status: Current - Active
Address :
16605 DEVINSHIRE ST
LOS ANGELES CA 91344
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: LORENZ, BROCK JASON
License/Registration Type: Dentist License
License Number: 61270 Primary Status: Current - Active
Address :
6622 Cedarwood Dr
HUNTINGTON BEACH CA 92648-6658
ORANGE COUNTY
