KONG XING WANG DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****14

License Status

NOT RENEWED

Business

Title

DMD

First Name

KONG

Middle

XING

Last Name

WANG

Business Name

KONG XING WANG DMD

Original Issue Date

08/23/2019

Effective Date

08/23/2019

Expiration Date

01/31/2022

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022