LEE D FILLAK DMD 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

LEE

Middle

Last Name

FILLAK

Suffix

DMD

Business Name

LEE D FILLAK DMD

Original Issue Date

09/27/1996

Effective Date

08/04/2009

Expiration Date

09/30/2012

City

BOURBONNAIS

State

Zip

60914

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012