Dental Board of California
Licensing details for: 3403
Name: STANFORD RANCH DENTAL OFFICE
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Partnership
Address of Record
6000 FAIRWAY STE #18
ROCKLIN CA 95677
PLACER county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KHODAI, SHAHRAM
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: KHODAI, SHAHRAM
License/Registration Type: Dentist License
License Number: 43027 Primary Status: Current - Active
Address :
3517 Marconi Ave #105
SACRAMENTO CA 95821
SACRAMENTO COUNTY
