SPENCER CHONG NICHOLSON 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

SPENCER

Middle

CHONG

Last Name

NICHOLSON

Business Name

SPENCER CHONG NICHOLSON

Original Issue Date

08/14/2001

Effective Date

08/14/2001

Expiration Date

09/30/2004

City

NAPERVILLE

State

Zip

60564

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005