MARY R PHAM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

Title

DDS

First Name

MARY

Middle

Last Name

PHAM

Business Name

MARY R PHAM DDS

Original Issue Date

01/25/2010

Effective Date

01/25/2010

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012