MICHAEL SCOTT GIDEON Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****07

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

SCOTT

Last Name

GIDEON

Business Name

MICHAEL SCOTT GIDEON

Original Issue Date

12/17/2004

Effective Date

08/04/2009

Expiration Date

09/30/2012

City

ORLAND PARK

State

Zip

60462

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012