SUSAN C GALLEGOS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

REGISTERED DENTAL HYGIENIST

License Number

020002287

License Status

NOT RENEWED

Business

First Name

SUSAN C

Last Name

GALLEGOS

Business Name

SUSAN C GALLEGOS

Original Issue Date

07/03/1974

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

ORLAND PARK

State

Zip

60462

County

COOK

Ever Disciplined

LastModifiedDate

11/04/2009

Case Number

2008005373

Action

Refuse To Renew

Discipline Start Date

04/13/2009

Discipline Reason

after forged and filled prescriptions for Vicodin.