RUSSELL A DIXON JR DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000279

License Status

CANCELLED

Business

First Name

RUSSELL A

Last Name

DIXON JR

Suffix

DDS

Business Name

RUSSELL A DIXON JR DDS

Original Issue Date

10/12/1990

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

LastModifiedDate

06/04/2009