BRAD S BUCKINGHAM DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****27

License Status

NOT RENEWED

Business

First Name

BRAD

Middle

Last Name

BUCKINGHAM

Suffix

DMD

Business Name

BRAD S BUCKINGHAM DMD

Original Issue Date

07/19/2012

Effective Date

07/19/2012

Expiration Date

09/30/2015

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016