TIFFANY LATRICE BOLEN DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001393

License Status

EXPIRED

Business

First Name

TIFFANY

Middle

LATRICE

Last Name

BOLEN

Suffix

DDS

Business Name

TIFFANY LATRICE BOLEN DDS

Original Issue Date

04/21/2003

Effective Date

04/21/2003

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005