ALISSARA GENA NIMSUWAN DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

Title

DMD

First Name

ALISSARA

Middle

GENA

Last Name

NIMSUWAN

Business Name

ALISSARA GENA NIMSUWAN DMD

Original Issue Date

06/15/2016

Effective Date

06/15/2016

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60640

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018