RUSSELL E LEIST JR DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****02

License Status

NOT RENEWED

Business

First Name

RUSSELL E

Last Name

LEIST JR

Suffix

DDS

Business Name

RUSSELL E LEIST JR DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2006

City

BLOOMINGDALE

State

Zip

60108

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006