LAUREN THUY-VY PHAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****85

License Status

NOT RENEWED

Business

First Name

LAUREN

Middle

THUY-VY

Last Name

PHAN

Business Name

LAUREN THUY-VY PHAN

Original Issue Date

10/25/2001

Effective Date

10/25/2001

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005