JAY A VANDERVORT 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

JAY A

Last Name

VANDERVORT

Business Name

JAY A VANDERVORT

Original Issue Date

02/16/1988

Effective Date

02/16/1988

Expiration Date

09/30/1990

City

LISLE

State

Zip

60532

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005