PETER EDWARD BLAZEK DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****09

License Status

NOT RENEWED

Business

First Name

PETER EDWARD

Last Name

BLAZEK

Suffix

DDS

Business Name

PETER EDWARD BLAZEK DDS

Original Issue Date

01/04/1991

Effective Date

06/12/2015

Expiration Date

09/30/2018

City

DARIEN

State

Zip

60561

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018