LAVERNE ANN FERGUSON 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

LAVERNE ANN

Last Name

FERGUSON

Business Name

LAVERNE ANN FERGUSON

Original Issue Date

08/04/1982

Effective Date

08/04/1982

Expiration Date

09/30/1984

City

BROADVIEW

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005