MARK JAMES BROOMHEAD DDS 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

MARK

Middle

JAMES

Last Name

BROOMHEAD

Suffix

DDS

Business Name

MARK JAMES BROOMHEAD DDS

Original Issue Date

07/25/2005

Effective Date

11/12/2015

Expiration Date

09/30/2018

City

SOUTH HOLLAND

State

Zip

60473

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018