STEPHANIE M MODISETT DDS Dentist License verification

Business Entity

INOPERATIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****12

License Status

INOPERATIVE

Business

First Name

STEPHANIE M

Last Name

MODISETT

Suffix

DDS

Business Name

STEPHANIE M MODISETT DDS

Original Issue Date

09/17/1997

Effective Date

09/17/1997

Expiration Date

09/30/1998

City

CHICAGO

State

Zip

60617

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005