BLAKE K KUNIMOTO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019025927

License Status

NOT RENEWED

Business

First Name

BLAKE

Middle

Last Name

KUNIMOTO

Business Name

BLAKE K KUNIMOTO

Original Issue Date

08/05/2002

Effective Date

10/01/2006

Expiration Date

09/30/2009

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/08/2010