BLAKE K KITAMURA DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001722

License Status

EXPIRED

Business

Title

DDS

First Name

BLAKE

Middle

Last Name

KITAMURA

Business Name

BLAKE K KITAMURA DDS

Original Issue Date

05/15/2009

Effective Date

07/01/2009

Expiration Date

07/01/2010

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

LastModifiedDate

07/08/2010