FONG WONG DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001333

License Status

NOT RENEWED

Business

First Name

FONG

Last Name

WONG

Suffix

DDS

Business Name

FONG WONG DDS

Original Issue Date

05/06/2002

Effective Date

05/06/2002

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Maxillofacial Prosthetics

Ever Disciplined

LastModifiedDate

10/12/2005