LEE D FILLAK DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018000640

License Status

NOT RENEWED

Business

First Name

LEE

Middle

Last Name

FILLAK

Suffix

DMD

Business Name

LEE D FILLAK DMD

Original Issue Date

07/08/1992

Effective Date

07/08/1992

Expiration Date

06/30/1994

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Endodontics

Ever Disciplined

LastModifiedDate

10/12/2005