MICHELLE SARAH MODAFF DDS - Dentist License in Illinois | # 018001194

MICHELLE SARAH MODAFF DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001194

License Status

NOT RENEWED

Business

N

First Name

MICHELLE

Middle

SARAH

Last Name

MODAFF

Suffix

DDS

Business Name

MICHELLE SARAH MODAFF DDS

Original Issue Date

08/19/1999

Effective Date

08/19/1999

Expiration Date

06/30/2000

State

IL

Specialty/Qualifier

General Practice Residency

Ever Disciplined

N

LastModifiedDate

10/12/2005