JACK S BLOCK Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

License Status

NOT RENEWED

Business

First Name

JACK S

Last Name

BLOCK

Business Name

JACK S BLOCK

Original Issue Date

01/01/1998

Expiration Date

09/30/1988

City

CHICAGO

State

Zip

60659

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005