PHILLIP K MALLOW 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

PHILLIP K

Last Name

MALLOW

Business Name

PHILLIP K MALLOW

Original Issue Date

09/02/1988

Effective Date

09/02/1988

Expiration Date

09/30/1990

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005