LYLA AZZAM DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****05

License Status

ACTIVE

Business

Title

DDS

First Name

LYLA

Last Name

AZZAM

Business Name

LYLA AZZAM DDS

Original Issue Date

11/15/2022

Effective Date

09/19/2024

Expiration Date

09/30/2027

City

PLAINFIELD

State

Zip

60585

County

WILL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/19/2024