TIMOTHY M BLIEDEN Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****32

License Status

NOT RENEWED

Business

First Name

TIMOTHY M

Last Name

BLIEDEN

Business Name

TIMOTHY M BLIEDEN

Original Issue Date

06/15/1988

Effective Date

06/15/1988

Expiration Date

09/30/1992

City

LAGRANGE

State

Zip

60525

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005