PETER RALPH VANDERSLOOT DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001519

License Status

ACTIVE

Business

First Name

PETER

Middle

RALPH

Last Name

VANDERSLOOT

Suffix

DDS

Business Name

PETER RALPH VANDERSLOOT DDS

Original Issue Date

09/29/2004

Effective Date

09/29/2004

Expiration Date

01/31/3004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Endodontics

Ever Disciplined

LastModifiedDate

10/12/2005