RUSSELL A DIXON JR DDS Dentist License verification

Business Entity

CANCELLED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****32

License Status

CANCELLED

Business

First Name

RUSSELL A

Last Name

DIXON JR

Suffix

DDS

Business Name

RUSSELL A DIXON JR DDS

Original Issue Date

01/01/1998

Effective Date

07/24/2006

Expiration Date

09/30/2009

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/04/2009