Dental Board of California
Licensing details for: 19659
Name: SIMPLE DENTAL SOUTHGATE DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
8617 California Ave
SOUTH GATE CA 90280
LOS ANGELES county
Map
License Relationships
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: JABAITI, TARIQ
License/Registration Type: Dentist License
License Number: 102526 Primary Status: Current - Active
Address :
8641 Wilshire Blvd
Suite 125
BEVERLY HILLS CA 90211-2900
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: KEIHANI, KOUROSH
License/Registration Type: Dentist License
License Number: 63776 Primary Status: Current - Active
Address :
5000 Parkway Calabasas
unit 308
CALABASAS CA 91302
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: Cohen, Mahyar
License/Registration Type: Dentist License
License Number: 100266 Primary Status: Current - Active
Address :
5243 Yarmouth Ave
22
ENCINO CA 91316-3109
LOS ANGELES COUNTY
