Phatkunya Mahavong
ActiveIllinois license 020013839
License
- Licensed by
- Illinois Department of Financial and Professional Regulation
- License number
- 020013839
- Status
- Active
- First issued
- January 3, 2012
- Expires
- September 30, 2027
- License holder
- Phatkunya Mahavong
- Entity type
- Individual
Classifications
- Registered Dental Hygienist Dental
More from the license record
- Current term began
- 09/30/2024
Contact
Rockford, IL 61109
Winnebago County