BLAKE K KITAMURA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****68

License Status

NOT RENEWED

Business

Title

DDS

First Name

BLAKE

Middle

Last Name

KITAMURA

Business Name

BLAKE K KITAMURA DDS

Original Issue Date

06/23/2010

Effective Date

01/22/2013

Expiration Date

09/30/2015

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016