KIRA KRISTEN FUNDERBURK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****77

License Status

NOT RENEWED

Business

First Name

KIRA

Middle

KRISTEN

Last Name

FUNDERBURK

Business Name

KIRA KRISTEN FUNDERBURK

Original Issue Date

10/06/2008

Effective Date

08/24/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60602

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012