TITUS J WONGK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****79

License Status

NOT RENEWED

Business

First Name

TITUS

Middle

Last Name

WONGK

Business Name

TITUS J WONGK

Original Issue Date

10/01/2018

Effective Date

10/01/2018

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60615

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022