BLAKE K KITAMURA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019028371

License Status

NOT RENEWED

Business

Title

DDS

First Name

BLAKE

Middle

Last Name

KITAMURA

Business Name

BLAKE K KITAMURA DDS

Original Issue Date

06/23/2010

Effective Date

07/13/2012

Expiration Date

09/30/2015

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

02/08/2016