SAM PARK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000572

License Status

NOT RENEWED

Business

First Name

SAM

Last Name

PARK

Business Name

SAM PARK

Original Issue Date

10/16/2002

Effective Date

06/12/2015

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Conscious Sedation, Parenteral

Ever Disciplined

LastModifiedDate

10/31/2018