JI WON MA DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****61

License Status

ACTIVE

Business

First Name

Middle

WON

Last Name

Suffix

DMD

Business Name

JI WON MA DMD

Original Issue Date

06/02/2014

Effective Date

05/16/2024

Expiration Date

09/30/2027

City

PEORIA

State

Zip

61604

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/16/2024