PARHAM MANSOURI Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

RESTRICTED FACULTY LICENSE

License Number

136000098

License Status

EXPIRED

Business

First Name

PARHAM

Last Name

MANSOURI

Business Name

PARHAM MANSOURI

Original Issue Date

07/12/2004

Effective Date

07/12/2004

Expiration Date

06/30/2006

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

07/27/2006