MICHAEL DAVID DEGOULD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****25

License Status

NOT RENEWED

Business

First Name

MICHAEL DAVID

Last Name

DEGOULD

Business Name

MICHAEL DAVID DEGOULD

Original Issue Date

03/15/1991

Effective Date

03/15/1991

Expiration Date

09/30/1998

City

DEERFIELD

State

Zip

60015

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/23/2012