AGATHA N DZIEDZIECH DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

First Name

AGATHA

Middle

Last Name

DZIEDZIECH

Suffix

DDS

Business Name

AGATHA N DZIEDZIECH DDS

Original Issue Date

10/24/2003

Effective Date

10/24/2003

Expiration Date

09/30/2006

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

III

Ever Disciplined

LastModifiedDate

02/08/2007