SUSAN A STACKER DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****06

License Status

NOT RENEWED

Business

First Name

SUSAN A

Last Name

STACKER

Suffix

DDS

Business Name

SUSAN A STACKER DDS

Original Issue Date

03/18/1996

Effective Date

03/18/1996

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005