SIVARAMAN PRAKASAM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED SPECIALIST IN DENTISTRY

License Number

021002506

License Status

NOT RENEWED

Business

First Name

SIVARAMAN

Last Name

PRAKASAM

Business Name

SIVARAMAN PRAKASAM

Original Issue Date

04/24/2013

Effective Date

08/29/2018

Expiration Date

01/31/2022

City

PORTLAND

State

Zip

97006

County

OREGON

Specialty/Qualifier

PERIODONTICS

Ever Disciplined

LastModifiedDate

05/09/2022