DIANA MANDEL TATCH Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****11

License Status

NOT RENEWED

Business

First Name

DIANA

Last Name

MANDEL TATCH

Business Name

DIANA MANDEL TATCH

Original Issue Date

11/12/2002

Effective Date

11/12/2002

Expiration Date

09/30/2004

City

CHICAGO

State

Zip

60618

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005