HOMAIRA AVENDANO Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****04

License Status

NOT RENEWED

Business

First Name

HOMAIRA

Last Name

AVENDANO

Business Name

HOMAIRA AVENDANO

Original Issue Date

09/02/2010

Effective Date

09/02/2010

Expiration Date

09/30/2012

City

ROUND LAKE BEACH

State

Zip

60073

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012