SO EUN PARK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****32

License Status

NOT RENEWED

Business

First Name

SO EUN

Last Name

PARK

Business Name

SO EUN PARK

Original Issue Date

07/02/2020

Effective Date

11/21/2021

Expiration Date

09/30/2024

City

BELOIT

State

Zip

53511

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025