TYSON ZACKEY 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

TYSON

Last Name

ZACKEY

Business Name

TYSON ZACKEY

Original Issue Date

03/23/1988

Effective Date

03/23/1988

Expiration Date

09/30/1990

City

CHICAGO

State

Zip

60613

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005