CHRISTOPHER N MODJESKI DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****20

License Status

CANCELLED

Business

First Name

CHRISTOPHER N

Last Name

MODJESKI

Suffix

DDS

Business Name

CHRISTOPHER N MODJESKI DDS

Original Issue Date

04/14/1992

Effective Date

04/14/1992

Expiration Date

09/30/2006

City

PERU

State

Zip

61354

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2006