CHANG JUN SONG DDS - Dentist License in Illinois | # 018001501

CHANG JUN SONG DDS

Business Entity

ACTIVE

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001501

License Status

ACTIVE

Business

N

First Name

CHANG

Middle

JUN

Last Name

SONG

Suffix

DDS

Business Name

CHANG JUN SONG DDS

Original Issue Date

09/29/2004

Effective Date

09/29/2004

Expiration Date

01/31/3004

State

IL

Specialty/Qualifier

Prosthodontics

Ever Disciplined

N

LastModifiedDate

10/12/2005