PHUONG THI NGUYEN 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

PHUONG

Middle

THI

Last Name

NGUYEN

Business Name

PHUONG THI NGUYEN DMD

Original Issue Date

01/10/2011

Effective Date

08/04/2015

Expiration Date

09/30/2018

City

PEORIA

State

Zip

61604

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018