JEFFERSON C BROCK DDS 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

JEFFERSON C

Last Name

BROCK

Suffix

DDS

Business Name

JEFFERSON C BROCK DDS

Original Issue Date

01/01/1998

Effective Date

10/23/2018

Expiration Date

01/31/2022

City

SKOKIE

State

Zip

60076

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022