MICHELLE SARAH MODAFF DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001194

License Status

NOT RENEWED

Business

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

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005