PHENNATDA POLPORNVITOON DMD - Dentist License in Illinois | # 019032839

PHENNATDA POLPORNVITOON DMD

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019032839

License Status

NOT RENEWED

Business

N

Title

DMD

First Name

PHENNATDA

Last Name

POLPORNVITOON

Business Name

PHENNATDA POLPORNVITOON DMD

Original Issue Date

07/27/2020

Effective Date

07/27/2020

Expiration Date

01/31/2022

City

CHICAGO

State

IL

Zip

60612

County

COOK

Ever Disciplined

N

LastModifiedDate

05/09/2022