Dental Board of California
Licensing details for: 3273
Name: LAKE FOREST DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
23082 RIDGE ROUTE DRIVE SUITE A
LAKE FOREST CA 92630
ORANGE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: MEHRVARZI, MEHRDOKHT
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: MEHRVARZI, MEHRDOKHT
License/Registration Type: Dentist License
License Number: 39184 Primary Status: Current - Active
Address :
PO Box 16716
IRVINE CA 92623-6716
ORANGE COUNTY
