DERIK P DECONINCK - Dentist License in Illinois | # 018000867

DERIK P DECONINCK

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000867

License Status

NOT RENEWED

Business

N

First Name

DERIK

Middle

P

Last Name

DECONINCK

Business Name

DERIK P DECONINCK

Original Issue Date

07/14/1995

Effective Date

07/14/1995

Expiration Date

06/30/1996

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005