DANIEL B DIETZ DDS Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****02

License Status

INOPERATIVE

Business

First Name

DANIEL B

Last Name

DIETZ

Suffix

DDS

Business Name

DANIEL B DIETZ DDS

Original Issue Date

03/07/1996

Effective Date

03/07/1996

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005