PHATKUNYA MAHAVONG Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020013839

License Status

ACTIVE

Business

First Name

PHATKUNYA

Last Name

MAHAVONG

Business Name

PHATKUNYA MAHAVONG

Original Issue Date

01/03/2012

Effective Date

09/30/2024

Expiration Date

09/30/2027

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/30/2024