ROBERT A GOLDBERG 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

ROBERT

Middle

Last Name

GOLDBERG

Suffix

DDS

Business Name

ROBERT A GOLDBERG DDS

Original Issue Date

03/19/2004

Effective Date

03/19/2004

Expiration Date

09/30/2004

City

EVANSTON

State

Zip

60201

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005