SHADEE T MANSOUR Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

DENTAL SEDATION PERMIT

License Number

137001081

License Status

ACTIVE

Business

First Name

SHADEE

Middle

Last Name

MANSOUR

Business Name

SHADEE T MANSOUR

Original Issue Date

03/02/2021

Effective Date

05/14/2024

Expiration Date

09/30/2027

City

BARRINGTON

State

Zip

60010

County

LAKE

Specialty/Qualifier

CONSCIOUS SEDATION - PERMIT A

Ever Disciplined

LastModifiedDate

05/14/2024