TALYA T MINTZ DDS - Dentist License in Illinois | # 018001433

TALYA T MINTZ DDS

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001433

License Status

EXPIRED

Business

N

First Name

TALYA

Middle

T

Last Name

MINTZ

Suffix

DDS

Business Name

TALYA T MINTZ DDS

Original Issue Date

08/22/2003

Effective Date

08/22/2003

Expiration Date

06/30/2004

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005