TODD TRABOR PUCKETT DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001147

License Status

NOT RENEWED

Business

First Name

TODD

Middle

TRABOR

Last Name

PUCKETT

Suffix

DMD

Business Name

TODD TRABOR PUCKETT DMD

Original Issue Date

02/08/1999

Effective Date

02/08/1999

Expiration Date

01/02/2001

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005