ELAINE GENEVIEVE WONG Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

NOT RENEWED

Business

First Name

ELAINE GENEVIEVE

Last Name

WONG

Business Name

ELAINE GENEVIEVE WONG

Original Issue Date

08/19/1987

Effective Date

08/19/1987

Expiration Date

09/30/1990

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005