MANUEL ENRIQUE DIAZ - Dentist License in Illinois | # 018001328

MANUEL ENRIQUE DIAZ

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001328

License Status

EXPIRED

Business

N

First Name

MANUEL

Middle

ENRIQUE

Last Name

DIAZ

Business Name

MANUEL ENRIQUE DIAZ

Original Issue Date

04/12/2002

Effective Date

04/12/2002

Expiration Date

06/30/2006

State

IL

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

N

LastModifiedDate

07/27/2006