SAMUEL JON WILSON 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

SAMUEL

Middle

JON

Last Name

WILSON

Suffix

DDS

Business Name

SAMUEL JON WILSON DDS

Original Issue Date

01/01/1998

Expiration Date

09/30/2004

City

CHICAGO

State

Zip

60628

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005