LAUREN THUY-VY PHAN - Dentist License in Illinois | # 018001518

LAUREN THUY-VY PHAN

Business Entity

ACTIVE

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001518

License Status

ACTIVE

Business

N

First Name

LAUREN

Middle

THUY-VY

Last Name

PHAN

Business Name

LAUREN THUY-VY PHAN

Original Issue Date

09/29/2004

Effective Date

09/29/2004

Expiration Date

01/31/3004

State

IL

Specialty/Qualifier

Endodontics

Ever Disciplined

N

LastModifiedDate

10/12/2005