CLARENCE HERBERT PETERSON JR Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****15

License Status

NOT RENEWED

Business

First Name

CLARENCE HERBERT

Last Name

PETERSON JR

Business Name

CLARENCE HERBERT PETERSON JR

Original Issue Date

01/01/1998

Expiration Date

09/30/1990

City

SKOKIE

State

Zip

60077

County

COOK

Controlled Substance Schedule

III

Ever Disciplined

LastModifiedDate

10/13/2005