SHANNON MICHELLE LEWIS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****28

License Status

NOT RENEWED

Business

First Name

SHANNON

Middle

MICHELLE

Last Name

LEWIS

Business Name

SHANNON MICHELLE LEWIS

Original Issue Date

03/29/2000

Effective Date

03/29/2000

Expiration Date

09/30/2002

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/17/2005