LILY KEN LAIJ DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

First Name

LILY

Middle

KEN

Last Name

LAIJ

Suffix

DDS

Business Name

LILY KEN LAIJ DDS

Original Issue Date

04/09/1984

Effective Date

08/29/2018

Expiration Date

01/31/2022

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022