LONG P PHAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****47

License Status

NOT RENEWED

Business

First Name

LONG

Middle

Last Name

PHAM

Business Name

LONG P PHAM

Original Issue Date

06/12/2009

Effective Date

06/19/2018

Expiration Date

01/31/2022

City

CAROL STREAM

State

Zip

60188

County

DUPAGE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022