JAMES WILLIAM BLACKBURN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001232

License Status

NOT RENEWED

Business

First Name

JAMES

Middle

WILLIAM

Last Name

BLACKBURN

Suffix

DDS

Business Name

JAMES WILLIAM BLACKBURN DDS

Original Issue Date

06/29/2000

Effective Date

06/29/2000

Expiration Date

06/30/2001

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Endodontics

Ever Disciplined

LastModifiedDate

10/12/2005