OMAR R CRUZ 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

OMAR

Middle

Last Name

CRUZ

Business Name

OMAR R CRUZ

Original Issue Date

10/25/2006

Effective Date

10/25/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009