NHUNG T N PHAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

First Name

NHUNG

Middle

T N

Last Name

PHAN

Business Name

NHUNG T N PHAN

Original Issue Date

10/04/2005

Effective Date

10/04/2005

Expiration Date

09/30/2006

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006