MARK J GRUNBERG Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

NOT RENEWED

Business

First Name

MARK J

Last Name

GRUNBERG

Business Name

MARK J GRUNBERG

Original Issue Date

12/06/1982

Effective Date

06/07/2018

Expiration Date

01/31/2022

City

CHICAGO

State

Zip

60651

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022