SARA MICHELLE FAGEN DMD Dentist License verification

Business Entity

EXPIRED

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001919

License Status

EXPIRED

Business

Title

DMD

First Name

SARA

Middle

MICHELLE

Last Name

FAGEN

Business Name

SARA MICHELLE FAGEN DMD

Original Issue Date

07/08/2014

Effective Date

07/08/2014

Expiration Date

05/31/2017

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Periodontics

Ever Disciplined

LastModifiedDate

07/20/2017