FABIAN D LATOCHA DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****03

License Status

NOT RENEWED

Business

First Name

FABIAN

Middle

Last Name

LATOCHA

Suffix

DDS

Business Name

FABIAN D LATOCHA DDS

Original Issue Date

10/30/2002

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009