RAYMOND SAMSON BALONGAG DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****54

License Status

NOT RENEWED

Business

First Name

RAYMOND SAMSON

Last Name

BALONGAG

Suffix

DMD

Business Name

RAYMOND SAMSON BALONGAG DMD

Original Issue Date

01/01/1998

Expiration Date

09/30/2002

City

ELGIN

State

Zip

60123

County

KANE

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

10/17/2005