BENJAPORN KRUBSACK - Dentist License in Illinois | # 31*****10

BENJAPORN KRUBSACK

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

ACTIVE

Business

N

First Name

BENJAPORN

Last Name

KRUBSACK

Business Name

BENJAPORN KRUBSACK

Original Issue Date

08/27/2022

Effective Date

07/25/2024

Expiration Date

09/30/2027

City

LOVES PARK

State

IL

Zip

61111

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

N

LastModifiedDate

07/25/2024