SAM PARK - Dentist License in Illinois | # 137000572

SAM PARK

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000572

License Status

NOT RENEWED

Business

N

First Name

SAM

Last Name

PARK

Business Name

SAM PARK

Original Issue Date

10/16/2002

Effective Date

06/12/2015

Expiration Date

09/30/2018

State

IL

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

N

LastModifiedDate

10/31/2018