DONG-PHUONG T LY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****37

License Status

NOT RENEWED

Business

First Name

DONG-PHUONG

Middle

Last Name

Business Name

DONG-PHUONG T LY

Original Issue Date

12/04/2002

Effective Date

12/04/2002

Expiration Date

09/30/2004

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005