KELLY AIDAN BLUNDELL DMD Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001345

License Status

EXPIRED

Business

First Name

KELLY

Middle

AIDAN

Last Name

BLUNDELL

Suffix

DMD

Business Name

KELLY AIDAN BLUNDELL DMD

Original Issue Date

06/19/2002

Effective Date

06/19/2002

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatric Dentist

Ever Disciplined

LastModifiedDate

07/30/2018