TAKEHISA RICHARD TANAKA DDS - Dentist License in Illinois | # 018001313

TAKEHISA RICHARD TANAKA DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001313

License Status

NOT RENEWED

Business

N

First Name

TAKEHISA

Middle

RICHARD

Last Name

TANAKA

Suffix

DDS

Business Name

TAKEHISA RICHARD TANAKA DDS

Original Issue Date

11/20/2001

Effective Date

11/20/2001

Expiration Date

08/31/2002

State

IL

Specialty/Qualifier

Prosthodontics

Ever Disciplined

N

LastModifiedDate

10/12/2005