JACK ROSEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

First Name

JACK

Last Name

ROSEN

Business Name

JACK ROSEN

Original Issue Date

01/01/1998

Expiration Date

06/01/1982

City

SKOKIE

State

Zip

60076

County

COOK

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/13/2005