THEOPHILUS BURRELL GRAY DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****26

License Status

NOT RENEWED

Business

First Name

THEOPHILUS

Middle

BURRELL

Last Name

GRAY

Suffix

DDS

Business Name

THEOPHILUS BURRELL GRAY DDS

Original Issue Date

01/01/1998

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60649

County

COOK

Controlled Substance Schedule

II III V

Ever Disciplined

LastModifiedDate

11/04/2009