ALLEN PONDEVIDA MOMONGAN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000783

License Status

NOT RENEWED

Business

First Name

ALLEN PONDEVIDA

Last Name

MOMONGAN

Suffix

DDS

Business Name

ALLEN PONDEVIDA MOMONGAN DDS

Original Issue Date

07/05/1994

Effective Date

07/05/1994

Expiration Date

06/30/1995

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005