ALLEN PONDEVIDA MOMONGAN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000393

License Status

INACTIVE

Business

First Name

ALLEN PONDEVIDA

Last Name

MOMONGAN

Suffix

DDS

Business Name

ALLEN PONDEVIDA MOMONGAN DDS

Original Issue Date

11/21/1995

Effective Date

11/21/1995

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

10/13/2005