KWONIL PARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****74

License Status

NOT RENEWED

Business

First Name

KWONIL

Last Name

PARK

Suffix

DDS

Business Name

KWONIL PARK DDS

Original Issue Date

07/28/2003

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009