Dental Board of California
Licensing details for: 4335
Name: A PRIVATE DENTAL GROUP, FARAJZADEH & BAKER
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Corporation
Address of Record
6794 LA JOLLA BLVD
LA JOLLA CA 92037
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: FARAJZADEH, EDWARD
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: BAKER, BRUCE BAKHSHI
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: FARAJZADEH, EDWARD
License/Registration Type: Dentist License
License Number: 33031 Primary Status: Current - Active
Address :
13983 Mango Dr
106
DEL MAR CA 92014-3131
SAN DIEGO 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: BAKER, BRUCE BAKHSHI
License/Registration Type: Dentist License
License Number: 32267 Primary Status: Voluntary Surrendered
Address :
PO BOX 669
POWAY CA 92074
SAN DIEGO COUNTY
