GINA MIRA JACOBSEN DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****12

License Status

NOT RENEWED

Business

First Name

GINA

Middle

MIRA

Last Name

JACOBSEN

Suffix

DDS

Business Name

GINA MIRA JACOBSEN DDS

Original Issue Date

05/30/2013

Effective Date

08/07/2015

Expiration Date

09/30/2018

City

WESTCHESTER

State

Zip

60154

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018