RYAN DAVID HILLAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

NOT RENEWED

Business

First Name

RYAN

Middle

DAVID

Last Name

HILLAM

Business Name

RYAN DAVID HILLAM

Original Issue Date

07/20/2001

Effective Date

07/20/2001

Expiration Date

09/30/2002

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005