PETER EDWARD BLAZEK DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

CANCELLED

Business

First Name

PETER EDWARD

Last Name

BLAZEK

Suffix

DDS

Business Name

PETER EDWARD BLAZEK DDS

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

DARIEN

State

Zip

60561

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005