SUZY AZALEA DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137000786

License Status

NOT RENEWED

Business

First Name

SUZY

Last Name

AZALEA

Suffix

DMD

Business Name

SUZY AZALEA DMD

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

09/30/2012

City

LISLE

State

Zip

60532

County

DUPAGE

Specialty/Qualifier

DEEP SEDATION AND GENERAL ANESTHESIA

Ever Disciplined

LastModifiedDate

11/14/2012