TAKEHISA RICHARD TANAKA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001313

License Status

NOT RENEWED

Business

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

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Prosthodontics

Ever Disciplined

LastModifiedDate

10/12/2005