LUIS PEDRO MIRON CARCAMO Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

ACTIVE

Business

First Name

LUIS

Middle

PEDRO

Last Name

MIRON CARCAMO

Business Name

LUIS PEDRO MIRON CARCAMO

Original Issue Date

12/13/2024

Effective Date

12/13/2024

Expiration Date

09/30/2027

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/24/2025