KENNETH LEROY ANDERSON DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001639

License Status

CANCELLED

Business

First Name

KENNETH

Middle

LEROY

Last Name

ANDERSON

Suffix

DDS

Business Name

KENNETH LEROY ANDERSON DDS

Original Issue Date

07/17/2007

Effective Date

07/17/2007

Expiration Date

06/30/2011

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Oral and Maxillofacial Surgery

Ever Disciplined

LastModifiedDate

06/18/2007