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Licensing details for: 9261

Name: SMILE DENTAL PRACTICE, DR. M. MAZLOOM

License Type: Fictitious Name Permit

Primary Status: Cancelled

Organization Classification: Sole Owner

Previous Names: SMILE DENTAL PRACTICE DR M MAZLOOM

Address of Record

1510 SAN ANDRES STREET
SANTA BARBARA CA 93101
SANTA BARBARA county
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Practice Location

1510 SAN ANDRES STREET
SANTA BARBARA CA 93101
SANTA BARBARA county
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Issuance Date

March 29, 2011

Expiration Date

August 31, 2019

Current Date / Time

June 6, 2025
2:10:58 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: MAZLOOM, MORTEZA

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: MAZLOOM, MORTEZA

License/Registration Type: Dentist License

License Number: 49596 Primary Status: Current - Active

Address :
5370 Hollister Ave
Suite A
SANTA BARBARA CA 93111-2303
SANTA BARBARA COUNTY

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