TAYLOR N PHAM Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****80

License Status

ACTIVE

Business

First Name

TAYLOR

Middle

Last Name

PHAM

Business Name

TAYLOR N PHAM

Original Issue Date

08/21/2019

Effective Date

05/24/2024

Expiration Date

09/30/2027

City

DEKALB

State

Zip

60115

County

DEKALB

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/24/2024