BLAINE PATRICK CUSACK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019019211

License Status

NOT RENEWED

Business

First Name

BLAINE

Middle

PATRICK

Last Name

CUSACK

Business Name

BLAINE PATRICK CUSACK

Original Issue Date

08/16/1984

Effective Date

11/10/2021

Expiration Date

09/30/2024

City

COUNTRYSIDE

State

Zip

60525

County

COOK

Ever Disciplined

LastModifiedDate

02/04/2025

Case Number

1991004993

Action

Fine

Discipline Start Date

08/18/1994

Discipline Reason

Aleged multiple violations of the Illinois Dental Practice Act.