AMANDA ALEXIS GOODMAN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****10

License Status

NOT RENEWED

Business

First Name

AMANDA

Middle

ALEXIS

Last Name

GOODMAN

Business Name

AMANDA ALEXIS GOODMAN

Original Issue Date

12/21/2004

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009