ABIGAIL ANNE TANGALAN MAZON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****85

License Status

NOT RENEWED

Business

First Name

ABIGAIL ANNE

Middle

TANGALAN

Last Name

MAZON

Business Name

ABIGAIL ANNE TANGALAN MAZON

Original Issue Date

09/04/2019

Effective Date

09/04/2019

Expiration Date

01/31/2022

City

SHORELINE

State

Zip

98133

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022