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Licensing details for: 5316

Name: ALISO NIGUEL DENTAL GROUP, MARK J WILSON, DDS &

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Association

Address of Record

24541 PACIFIC PARK DR
STE 105
ALISO VIEJO CA 92656
ORANGE county
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Issuance Date

January 4, 2005

Expiration Date

November 30, 2017

Current Date / Time

June 6, 2025
2:11:5 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: SHAHZADI, FARHANG

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: SHAHZADI, FARHANG

License/Registration Type: Dentist License

License Number: 47417 Primary Status: Current - Active

Address :
24541 Pacific Park Dr
SUITE 105
ALISO VIEJO CA 92656-3065
ORANGE COUNTY

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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: WILSON, MARK JONATHAN

License/Registration Type: Dentist License

License Number: 33687 Primary Status: Cancelled

Address :
49305 HWY 74
#191
PALM DESERT CA 92260
RIVERSIDE COUNTY

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