JOHN DOUGLAS BLOOM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****30

License Status

NOT RENEWED

Business

First Name

JOHN DOUGLAS

Last Name

BLOOM

Suffix

DDS

Business Name

JOHN DOUGLAS BLOOM DDS

Original Issue Date

03/26/1997

Effective Date

03/26/1997

Expiration Date

09/30/1998

City

HIGHLAND PARK

State

Zip

60035

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005