JACQUELINE THOMPSON-FERNANDEZ Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****22

License Status

NOT RENEWED

Business

First Name

JACQUELINE

Last Name

THOMPSON-FERNANDEZ

Business Name

JACQUELINE THOMPSON-FERNANDEZ

Original Issue Date

11/09/1984

Effective Date

11/09/1984

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60623

County

COOK

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/17/2005