EDWARD L MODESTO DDS - Dentist License in Illinois | # 137000307

EDWARD L MODESTO DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000307

License Status

NOT RENEWED

Business

N

First Name

EDWARD L

Last Name

MODESTO

Suffix

DDS

Business Name

EDWARD L MODESTO DDS

Original Issue Date

01/11/1992

Effective Date

08/13/2012

Expiration Date

09/30/2015

State

IL

Specialty/Qualifier

Deep Sedation and General Anesthesia

Ever Disciplined

N

LastModifiedDate

02/08/2016