BLAKE K KUNIMOTO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****53

License Status

NOT RENEWED

Business

First Name

BLAKE

Middle

Last Name

KUNIMOTO

Business Name

BLAKE K KUNIMOTO

Original Issue Date

09/16/2002

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009