LONG P PHAM - Dentist License in Illinois | # 019027905

LONG P PHAM

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019027905

License Status

NOT RENEWED

Business

N

First Name

LONG

Middle

P

Last Name

PHAM

Business Name

LONG P PHAM

Original Issue Date

05/12/2009

Effective Date

06/19/2018

Expiration Date

01/31/2022

State

IL

Ever Disciplined

N

LastModifiedDate

05/09/2022