Dental Board of California
Licensing details for: 19040
Name: ST GEORGE FAMILY DENTAL, PRACTICE OF SOROUR KIDS DENTAL GROUP, 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: SOROUR, THARWAT
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: SOROUR, SELVANA
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: SOROUR, THARWAT
License/Registration Type: Dentist License
License Number: 54393 Primary Status: Current - Active
Address :
13340 HAWTHORNE BLVD
HAWTHORNE CA 90250
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: SOROUR, SELVANA
License/Registration Type: Dentist License
License Number: 54394 Primary Status: Current - Active
Address :
13340 HAWTHORNE BLVD
HAWTHORNE CA 90250
LOS ANGELES COUNTY
