JONATHAN PHEN Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

ACTIVE

Business

First Name

JONATHAN

Last Name

PHEN

Business Name

JONATHAN PHEN

Original Issue Date

04/19/2023

Effective Date

07/22/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61611

County

TAZEWELL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/22/2024