JIMMY DUY PHAM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

Title

DDS

First Name

JIMMY

Middle

DUY

Last Name

PHAM

Business Name

JIMMY DUY PHAM DDS

Original Issue Date

04/14/2023

Effective Date

04/14/2023

Expiration Date

09/30/2024

City

GLEN CARBON

State

Zip

62034

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025