SAM AZZAM 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

SAM

Last Name

AZZAM

Business Name

SAM AZZAM

Original Issue Date

11/20/2013

Effective Date

10/25/2021

Expiration Date

09/30/2024

City

CHICAGO

State

Zip

60634

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025