KYLE JOSEPH FAIRBANKS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****33

License Status

ACTIVE

Business

First Name

KYLE

Middle

JOSEPH

Last Name

FAIRBANKS

Business Name

KYLE JOSEPH FAIRBANKS

Original Issue Date

06/05/2017

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60660

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024