KETLEN KRISTIAN BYSTROM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****31

License Status

NOT RENEWED

Business

First Name

KETLEN

Middle

KRISTIAN

Last Name

BYSTROM

Business Name

KETLEN KRISTIAN BYSTROM

Original Issue Date

08/28/2017

Effective Date

08/28/2017

Expiration Date

09/30/2018

City

DOWNERS GROVE

State

Zip

60515

Specialty/Qualifier

TEACHING INSTITUTION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018