SCOTT DAVID GOLDMAN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000766

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

DAVID

Last Name

GOLDMAN

Suffix

DDS

Business Name

SCOTT DAVID GOLDMAN DDS

Original Issue Date

09/17/2009

Effective Date

09/17/2009

Expiration Date

09/30/2012

City

LINCOLNSHIRE

State

Zip

60069

County

LAKE

Specialty/Qualifier

CONSCIOUS SEDATION, PARENTERAL

Ever Disciplined

LastModifiedDate

11/14/2012