MANUEL ENRIQUE DIAZ Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001328

License Status

EXPIRED

Business

First Name

MANUEL

Middle

ENRIQUE

Last Name

DIAZ

Business Name

MANUEL ENRIQUE DIAZ

Original Issue Date

04/12/2002

Effective Date

04/12/2002

Expiration Date

06/30/2006

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

LastModifiedDate

07/27/2006