KEVIN MICHAEL LANE 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

KEVIN

Middle

MICHAEL

Last Name

LANE

Business Name

KEVIN MICHAEL LANE

Original Issue Date

06/05/2009

Effective Date

06/05/2009

Expiration Date

09/30/2012

City

CHICAGO HEIGHTS

State

Zip

60411

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012