JESSICA R KAZEM DDS 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

JESSICA

Middle

Last Name

KAZEM

Suffix

DDS

Business Name

JESSICA R KAZEM DDS

Original Issue Date

05/20/2003

Effective Date

05/20/2003

Expiration Date

09/30/2004

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005