MILEN VITANOV VITANOV DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****88

License Status

NOT RENEWED

Business

Title

DMD

First Name

MILEN

Middle

VITANOV

Last Name

VITANOV

Business Name

MILEN VITANOV VITANOV DMD

Original Issue Date

10/03/2017

Effective Date

06/12/2018

Expiration Date

01/31/2022

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022