CLYDE J EXUM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****19

License Status

NOT RENEWED

Business

First Name

CLYDE

Middle

Last Name

EXUM

Business Name

CLYDE J EXUM

Original Issue Date

11/08/1984

Effective Date

11/08/1984

Expiration Date

09/30/2000

City

CHICAGO

State

Zip

60607

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005