GLENN W FORTNER Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000349

License Status

NOT RENEWED

Business

First Name

GLENN

Middle

Last Name

FORTNER

Business Name

GLENN W FORTNER

Original Issue Date

06/12/1989

Effective Date

06/12/1989

Expiration Date

06/30/1990

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005