Dental Board of California
Licensing details for: 18833
Name: LA JOLLA ENDODONTICS DENTAL GROUP OF BABAK SHOUSHTARI, D.M.D., 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: SHOUSHTARI, BABAK
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: SHOUSHTARI, BABAK
License/Registration Type: Dentist License
License Number: 47562 Primary Status: Current - Active
Address :
4130 La Jolla Village Dr
Suite 205
LA JOLLA CA 92037-9121
SAN DIEGO COUNTY
