ROBERT JAN BAZAN 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

Title

DDS

First Name

ROBERT

Middle

JAN

Last Name

BAZAN

Business Name

ROBERT JAN BAZAN DDS

Original Issue Date

11/12/1981

Effective Date

11/12/1981

Expiration Date

06/01/1982

City

CHICAGO

State

Zip

60632

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005