PETER S KIM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****57

License Status

NOT RENEWED

Business

First Name

PETER

Middle

Last Name

KIM

Suffix

DDS

Business Name

PETER S KIM DDS

Original Issue Date

08/03/2010

Effective Date

08/03/2010

Expiration Date

09/30/2012

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012