LACEY MONTIREY GREEN DDS Dentist License verification

Business Entity

INACTIVE

License Type

Dentist

Description

LICENSED DENTIST

License Number

019027837

License Status

INACTIVE

Business

First Name

LACEY

Middle

MONTIREY

Last Name

GREEN

Suffix

DDS

Business Name

LACEY MONTIREY GREEN DDS

Original Issue Date

10/24/2008

Effective Date

06/15/2009

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60605

County

COOK

Ever Disciplined

LastModifiedDate

06/06/2012