THALIA-RAE PERRYMAN CRIDDLE DMD 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

DMD

First Name

THALIA-RAE

Middle

PERRYMAN

Last Name

CRIDDLE

Business Name

THALIA-RAE PERRYMAN CRIDDLE DMD

Original Issue Date

08/22/2017

Effective Date

08/22/2017

Expiration Date

09/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/31/2018