ALLEN PONDEVIDA MOMONGAN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

First Name

ALLEN PONDEVIDA

Last Name

MOMONGAN

Suffix

DDS

Business Name

ALLEN PONDEVIDA MOMONGAN DDS

Original Issue Date

05/22/1995

Effective Date

08/20/2018

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022