KIAH A BALLANTINE Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019031865

License Status

NOT RENEWED

Business

First Name

KIAH

Middle

Last Name

BALLANTINE

Business Name

KIAH A BALLANTINE

Original Issue Date

08/28/2018

Effective Date

08/28/2018

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

05/09/2022