STANFORD M BASTACKY DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019017553

License Status

NOT RENEWED

Business

First Name

STANFORD M

Last Name

BASTACKY

Suffix

DMD

Business Name

STANFORD M BASTACKY DMD

Original Issue Date

04/28/1981

Effective Date

04/28/1981

Expiration Date

04/01/1982

City

PALATINE

State

Zip

60067

County

COOK

Ever Disciplined

LastModifiedDate

10/12/2005