NI VAN DMD Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****18

License Status

ACTIVE

Business

Title

DMD

First Name

Last Name

VAN

Business Name

NI VAN DMD

Original Issue Date

06/02/2017

Effective Date

05/25/2024

Expiration Date

09/30/2027

City

BURBANK

State

Zip

60459

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/25/2024