Dental Board of California
Licensing details for: 5786
Name: LAKE ELSINORE DENTAL GROUP, MARSHA TAVAKOLI, DDS
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
32235 MISSION TRAIL RD, STE 8
LAKE ELSINORE CA 92530
RIVERSIDE county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: LEVI, MARSHA TAVAKOLI
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: TAVAKILO, MARSHA
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: LEVI, MARSHA TAVAKOLI
License/Registration Type: Dentist License
License Number: 46223 Primary Status: Current - Active
Address :
6020 SEABLUFF DR #5
LOS ANGELES CA 90094
LOS ANGELES COUNTY
