RYAN MASAO MIZUMOTO DMD - Dentist License in Illinois | # 019028088

RYAN MASAO MIZUMOTO DMD

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019028088

License Status

NOT RENEWED

Business

N

Title

DMD

First Name

RYAN

Middle

MASAO

Last Name

MIZUMOTO

Business Name

RYAN MASAO MIZUMOTO DMD

Original Issue Date

07/16/2009

Effective Date

07/16/2009

Expiration Date

09/30/2012

State

IL

Ever Disciplined

N

LastModifiedDate

11/14/2012