FARIBA EDALAT DDS Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001409

License Status

EXPIRED

Business

First Name

FARIBA

Last Name

EDALAT

Suffix

DDS

Business Name

FARIBA EDALAT DDS

Original Issue Date

06/24/2003

Effective Date

06/24/2003

Expiration Date

06/30/2004

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

General Practice Residency

Ever Disciplined

LastModifiedDate

10/12/2005