PHENNATDA POLPORNVITOON DMD - Dentist License in Illinois | # 018002156

PHENNATDA POLPORNVITOON DMD

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018002156

License Status

EXPIRED

Business

N

Title

DMD

First Name

PHENNATDA

Last Name

POLPORNVITOON

Business Name

PHENNATDA POLPORNVITOON DMD

Original Issue Date

06/22/2020

Effective Date

07/01/2020

Expiration Date

06/30/2021

City

CHICAGO

State

IL

Zip

60612

County

COOK

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

N

LastModifiedDate

11/28/2022