HOSAN PARK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****86

License Status

NOT RENEWED

Business

Title

DDS

First Name

HOSAN

Last Name

PARK

Business Name

HOSAN PARK DDS

Original Issue Date

09/28/2017

Effective Date

09/28/2017

Expiration Date

09/30/2018

City

SEATTLE

State

Zip

98119

County

WISCONSIN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III

Ever Disciplined

LastModifiedDate

10/31/2018