RYAN MASAO MIZUMOTO DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****73

License Status

NOT RENEWED

Business

Title

DMD

First Name

RYAN

Middle

MASAO

Last Name

MIZUMOTO

Business Name

RYAN MASAO MIZUMOTO DMD

Original Issue Date

08/25/2009

Effective Date

08/25/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60607

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

11/14/2012