THUPTARA THUPVONG DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****96

License Status

ACTIVE

Business

Title

DMD

First Name

THUPTARA

Last Name

THUPVONG

Business Name

THUPTARA THUPVONG DMD

Original Issue Date

03/18/2003

Effective Date

09/27/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60622

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/27/2024