THEODORE LEE MOSS DMD 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

THEODORE

Middle

LEE

Last Name

MOSS

Suffix

DMD

Business Name

THEODORE LEE MOSS DMD

Original Issue Date

11/24/1992

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/04/2009