JESSICA FORTUNEE HAYATE DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****34

License Status

NOT RENEWED

Business

First Name

JESSICA

Middle

FORTUNEE

Last Name

HAYATE

Suffix

DMD

Business Name

JESSICA FORTUNEE HAYATE DMD

Original Issue Date

04/29/2014

Effective Date

04/29/2014

Expiration Date

09/30/2015

City

CHICAGO

State

Zip

60654

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2016