BENNETT H JACOBY Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000208

License Status

NOT RENEWED

Business

First Name

BENNETT

Middle

Last Name

JACOBY

Business Name

BENNETT H JACOBY

Original Issue Date

09/11/1987

Effective Date

09/11/1987

Expiration Date

07/01/1989

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

LastModifiedDate

10/12/2005